Important news for thousands of patients with colorectal polyps

The European Polyp Surveillance (EPoS) trial is the world’s largest randomized trial investigating surveillance of patients with colorectal polyps – i.e., precursors of colorectal cancer. 

The trial includes nearly 21,000 patients across eight European countries and investigates whether extending surveillance colonoscopy after polyp removal from the current 3 years to 5 years is equally effective. If so, this can save substantial healthcare resources and reduce unnecessary burdens on patients.

Good news for patients and the healthcare system

The first results from the EpoS trial show that:

1. The risk of colorectal cancer among patients with high-risk polyps is lower than previously thought: 99% of patients did not develop colorectal cancer within 5 years after polyp removal.
2. Surveillance colonoscopy can safely be delayed from the current interval of 3 years to 5 years.
3. Fewer colonoscopies reduce the burden on patients and free up healthcare resources while reducing costs.

Nearly 2,000 patients included in Denmark

In Denmark, nearly 2,000 patients have been included in the trial. Patients have been recruited at four regional hospitals in Central Denmark Region: Randers Regional Hospital, Horsens Regional Hospital, Viborg Regional Hospital, and Regional Hospital Gødstrup.

National principal investigator in Denmark, associate professor and consulting surgeon Rune Erichsen, says: 

”The endoscopy clinics have made a huge effort to recruit patients for the EPoS trial. With support from the Danish Cancer Society, we have been able to dedicate skilled nurses to the project. In addition, patients across the region have shown tremendous support for the project.  

Together, these efforts have made it possible to generate evidence that can potentially change clinical practice byreducing the need for surveillance colonoscopies among patients who have had polyps removed during colonoscopy.

Screening helps prevent colorectal cancer

Approximately 1.9 million people are diagnosed with colorectal cancer worldwide each year, including 4,500 in Denmark. Many countries have introduced screening programs to detect and prevent the disease, with Denmark introducing national screening for colorectal cancer in 2014. 

As screening has become more widespread, an increasing number of people is diagnosed with colorectal polyps. Some of these polyps are precursors to colorectal cancer. 

After polyp removal during colonoscopy, some patients are considered to be at high risk of developing new polyps or colorectal cancer. Current guidelines therefore recommend frequent surveillance with additional colonoscopies. The interval between these surveillance colonoscopies is the key focus of the EPoS trial.

Associate professor, consulting surgeon Rune Erichsen
University Clinic for Coloproctology and Endoscopy, Department of Clinical Medicine, Aarhus University
Department of Surgery, Randers Regional Hospital
Mail: re@clin.au.dk