More Evidence That Negative Screening Colonoscopy Can Be Followed by Intervals of More Than 10 Years

Douglas K. Rex, MD, MASGE reviewing Heisser T, et al. Gastroenterology 2020 Aug 7.

This study compared the incidence of advanced neoplasms in 2456 German screening colonoscopy patients who had a previous colonoscopy without polyps to the results from 12,033 first-time screening colonoscopy patients. The mean time interval since the previous colonoscopy was 11.3 years. The prevalence of advanced neoplasia in those with a negative colonoscopy within 20 years was 5.5% compared to 12.6% for first-time colonoscopy recipients. There was little variation in the advanced neoplasia findings across 5-year intervals, and even after 20 years, the prevalence was still reduced by 41%. Among the patients with previous negative colonoscopy results, risk factors, including sex, age, smoking history, family history, and body mass index, were not clearly associated with increased risk of advanced neoplasia, though the very highest risk group with multiple risk factors reached an advanced neoplasia incidence rate near 10%.


These data provide more support for recommending screening intervals longer than 10 years after high-quality screening colonoscopy. One issue is whether American patients will tolerate an absolute risk of advanced neoplasia and cancer at 10 years that is reduced from baseline risk but is not negligible.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Heisser T, Guo F, Niedermaier T, Holleczek B, Hoffmeister M, Brenner H. Low risk of advanced neoplasms for up to 20 years after negative colonoscopy: potential for personalized follow-up screening intervals. Gastroenterology 2020 Aug 7. (Epub ahead of print) (