Polyps ≥10 mm Alone: Low PCCRC Risk at 5 Years- Endoscopy Feb.26

Introduction

Post-polypectomy surveillance is one of the biggest drivers of colonoscopy workload worldwide. Current guidelines often label any polyp ≥10 mm as “high risk,” triggering a 3-year surveillance colonoscopy. But many endoscopists have questioned whether size alone—especially for 10–20 mm lesions that are completely resected and lack dysplasia—really carries enough cancer risk to justify early repeat colonoscopy.

This study asks a very practical question:

Do patients with a ≥10 mm polyp as their only “high-risk” feature actually have a higher post-colonoscopy colorectal cancer (PCCRC) risk than patients with no polyps?

Problem statement

The “≥10 mm = high risk” rule may be too blunt. It can create:

• unnecessary surveillance colonoscopies,
• increased cost and patient burden,
• and pressure on already stretched endoscopy capacity.

Yet, relaxing surveillance must be safe—especially in screening programs.

So the key gap is:

What is the real PCCRC risk over 5 years when size is the only high-risk feature?

What the study did:

Using the Dutch FIT-based national screening program data (quality-assured colonoscopies), the authors compared two groups:

• People with polyps ≥10 mm but no other high-risk features (no high-grade dysplasia, no dysplastic serrated lesions, no multiple high-risk findings).
• People with no polyps at baseline colonoscopy.

Because the Dutch guideline at that time recommended 5-year follow-up for a subgroup of these “size-only” patients, the authors could safely examine what happened over a 5-year window.

Key results clinicians should remember

1) Cancer risk was low—and not higher than polyp-free patients

Over 5 years, people with ≥10 mm polyps as the sole risk feature had a similarly low PCCRC risk compared with people who had no polyps.

2) This matters because it’s a large group

Most “high-risk” patients in real life fall into this category where size is the only high-risk feature—especially the 10–20 mm range.

3) Quality of the baseline colonoscopy matters more than polyp size alone

A major insight: PCCRC risk was strongly influenced by the endoscopist’s ADR. In other words, the safety of longer intervals depends heavily on performing a high-quality baseline colonoscopy.

Clinical interpretation

This paper challenges a common habit in surveillance:

treating “≥10 mm” as automatically equivalent to “high cancer risk.”

It suggests a more nuanced approach may be safe in the right setting—particularly when:

• the colonoscopy is high quality (good prep, complete exam),
• the lesion is completely resected (especially en bloc),
• there is no dysplasia/high-risk histology, and
• the endoscopist quality indicators (like ADR) are strong.

Practical takeaway for clinicians and endoscopy units

If confirmed in other settings, this evidence supports extending surveillance intervals for patients with a 10–20 mm polyp as the only high-risk feature, rather than automatically bringing everyone back in 3 years.

This could:

• reduce unnecessary procedures,
• improve colonoscopy capacity for higher-risk patients, and
• align surveillance intensity with actual cancer risk.

Conclusion;

In a national, quality-assured screening program, patients with ≥10 mm polyps without other high-risk features had PCCRC risk comparable to those with no polyps over a 5-year period. The study strongly suggests that colonoscopy quality and endoscopist performance may be more important than size alone when deciding surveillance intervals—especially for completely resected 10–20 mm lesions.