Surveillance Outcomes in an Australian Cohort Undergoing Piecemeal Polypectomy for Conventional Adenomas and Serrated Lesions

BACKGROUND AND AIMS: Current guidelines recommend early surveillance following piecemeal polypectomy due to recurrence risk; however, this contributes substantially to colonoscopy burden. We aimed to identify subgroups in which surveillance can be safely deferred beyond current guideline intervals. METHODS: We performed a two-center retrospective study of consecutive patients undergoing first (SC1) and second (SC2) surveillance colonoscopy following piecemeal resection. Primary outcome was histological recurrence; secondary outcome was detection of additional high-risk polyps. RESULTS: A total of 221 lesions, 130 conventional adenomas (CA) and 91 serrated lesions (SL), were resected piecemeal in 202 patients, with 76% removed using cold snare technique. Recurrence following cold resection occurred in 11% of CA ≥ 20 mm and 15% of CA < 20 mm, while recurrence in SL was low (5% for < 20 mm; 0% for ≥ 20 mm). Hot snare resection was predominantly used for larger CA (79% ≥ 20 mm) and was associated with a recurrence rate of 14%. At SC1, additional high-risk polyps were detected in 27% of patients, particularly following resection of larger index lesions. No advanced neoplasia was detected at SC2 in patients with serrated lesions without recurrence at SC1. CONCLUSIONS: In this real-world study, most piecemeal polypectomy was performed using cold snare technique. There was a clinically significant risk of recurrence in CA including those < 20 mm supporting current recommendations of surveillance at 6 months unless technical advances can be shown to reduce recurrence. Our findings suggest a lower risk of recurrence in SL of all sizes and if confirmed on further studies, surveillance intervals may be able to safely lengthen in these cases.