Colorectal Cancer Prevention : Surveillance of adenoma patients –towards more efficient guidelines

The aim of this thesis was to improve risk stratification of adenoma patients and suggest intervals for surveillance.

This thesis has 3 parts. In part I, we examined literature to estimate the frequency of complications (perforation and mortality) after colonoscopy. In part II, we investigated factors that were predictive for detecting advanced colorectal neoplasia (advanced adenoma and cancer) at surveillance colonoscopy. We further assessed how these predictors could be used to improve surveillance of adenoma patients. In part III, we evaluated to what extent guidelines for surveillance of adenoma patients are adhered to.

We concluded that adenoma-related predictors of advanced colorectal neoplasia should we used jointly to improve risk-stratification in surveillance guidelines. We recommended the use of a score chart to calculate a patients’ adenoma risk score. We proposed intervals for surveillance colonoscopy according to adenoma risk score, age and sex. Results of this thesis let to an update of the Dutch guideline for colonoscopy surveillance in 2013.