ClinicalTrials.gg
Enrolling by invitationNCT07198945STARLINGUpdated Oct 21, 2026

Six Versus Twelve Month Index Follow-up After Large Colon Polyp Resection

An interventional study of 6-month follow-up and 12-month follow-up in Colon Polyp, Adenoma and Serrated Polyp, sponsored by Indiana University. Enrolling by invitation at 10 sites in 3 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-21.

Sponsored by Indiana University · Not applicable, Interventional, and Prevention

Updated Oct 21, 2026Eligibility revisedGo to Updates ↓
Phase
Not applicable
Study type
Interventional
Enrollment
546
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The study will compare the use of a 6-month follow-up vs a 12-month follow-up after the removal of a large non-pedunculated polyp 20-50mm in size and without high grade dysplasia.

02

Conditions studied

  • Colon Polyp
  • Adenoma
  • Serrated Polyp
  • Recurrence, Local Neoplasm
  • Endoscopic Resection

Keywords

  • Polyp Resection
  • Colonoscopy
  • Recurrence
  • Surveillance Interval
  • Patient Experience
03

In context

Colonic Polyps

377 studies on the registry are indexed under Colonic Polyps; 57 are open to participants now.

This study's planned enrollment of 546 is above the median of 274 across 250 interventional studies indexed under Colonic Polyps.

Browse Colonic Polyps studies →

Lead sponsor

Indiana University is the lead sponsor of 986 studies on the registry; 198 are open to participants now.

Of its 148 completed or terminated interventional studies of FDA-regulated products, 118 (80%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

The criteria were revised on the registry on Oct 21, 2026. See what changed

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

Patient Criteria

  1. ≥ 18 years of age
  2. Ability to provide
  3. Willing and able to complete one electronic survey
  4. Presenting for colonoscopy for any indication
  5. Ability to understand the requirements of the study and agree to abide by the study restrictions and to return for the required assessments.

    Polyp Criteria

  6. Size 20-50 mm as documented with photo containing open snare of known size as comparison.
  7. Histology without high grade dysplasia:

    1. Conventional Adenoma: adenoma with or without villous components
    2. Serrated: hyperplastic or sessile serrated lesion

Exclusion criteria

Exclusion Criteria:

Patient Criteria

  1. Patients with confirmed diagnosis of inflammatory bowel disease, including Ulcerative Colitis and Crohn's Disease.
  2. Patients with a known or suspected diagnosis of any of the following polyposis or non-polyposis syndromes with known genetic mutations:

    • Familial Adenomatous Polyposis Syndrome
    • MUTYH associated Polyposis Syndrome
    • Juvenile Polyposis Syndrome
    • Cowden's Syndrome
    • Peutz-Jeghers Syndrome
    • Hereditary Non-Polyposis Colorectal Cancer Syndrome (HNPCC) or Lynch Syndrome
  3. Patients who have high grade dysplasia found in any polyp ≥ 20 mm removed at the index colonoscopy
  4. Patients who have any colorectal cancer by histologic diagnosis at index procedure
  5. Patients needing a colonoscopy 6 months or sooner for any indication following the index procedure including burden of synchronous disease, inadequate prep to assess for synchronous disease, inadequate prep that precludes resection of index large polyp, or other reason limiting ability to complete full examination of colon at time of resection.
  6. ASA ≥ 4 or documented coagulopathy or severe thrombocytopenia ( ≥ 2 or ≤ 20).
  7. Patients who have more than three ≥ 20mm polyps removed during the index colonoscopy
  8. Patients with significant medical problems that could compromise subject safety, limit the ability to complete the study, and/or compromise the objectives of the study per the judgement of the investigator.

    Polyp Criteria

  9. Polyp located at appendiceal orifice, ileocecal valve, or intradiverticulum
  10. Pedunculated or semi-pedunculated polyps (as defined by Paris Classification type Ip or Isp)
  11. A polyp that is classified as a traditional serrated adenoma.
  12. Polyps with features of invasive cancer
  13. Polyps that are not able to be removed with standard endoscopic techniques for any reason
  14. Polyps that are incompletely resected endoscopically at index procedure
  15. Polyps removed by endoscopic submucosal dissection (ESD) or by full thickness resection device (FTRD)
Terms in these criteria, in plain language(3)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

INR, PT and aPTT (clotting tests)

Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.

Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

05

Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
546 participants (estimated)

Study arms

  • Experimental
    6-month follow-up

    Patients will be recommended to complete their first surveillance procedure 6 months after the large polyp removal procedure in order to assess whether the polyp grew back.

    Procedure: 6-month follow-up

  • Experimental
    12-month follow-up

    Patients will be recommended to complete their first surveillance procedure 12 months after the large polyp removal procedure in order to assess whether the polyp grew back.

    Procedure: 12-month follow-up

Interventions

  • Procedure6-month follow-up

    Eligible patients randomized to the 6-month follow-up arm will undergo their first surveillance procedure 6 months after the removal of their large polyp to check for recurrent polyp tissue.

  • Procedure12-month follow-up

    Eligible patients randomized to the 12-month follow-up arm will undergo their first surveillance procedure 12 months after the removal of their large polyp to check for recurrent polyp tissue.

06

What researchers measure

Primary outcomes

  1. Rate of recurrence

    Rate of recurrence will be assessed by identification of recurrent polyp tissue at the follow-up procedure.

    Time frame: 1 day

Secondary outcomes

  1. Time of endoscopic management of recurrent polyp

    The time it takes to treat recurrent polyp at the follow-up procedure

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  2. Perceived difficulty of endoscopic treatment of recurrent polyp

    Perceived difficulty of endoscopic treatment of recurrent polyp will be assessed by the endoscopist based at the follow-up procedure on Likert scale 1 - 5 from very difficult to very easy.

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  3. Rate of malignancy identified at first surveillance colonoscopy

    The rate of malignancy measured at the first follow-up colonoscopy

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  4. Size of recurrent polyp at first surveillance colonoscopy

    The size of recurrent polyp tissue as measured by maximum size in millimeters

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  5. Number of distinct areas of recurrent polyp

    The number of areas of recurrent polyp tissue identified at the site of the prior large polyp

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  6. Rate of high grade dysplasia identified in recurrent polyp

    The rate of high grade dysplasia identified in recurrent polyp tissue.

    Time frame: After surveillance colonoscopy, typically 6 months to 12 months

  7. Need for advanced resection techniques to treat recurrent polyp

    Whether advanced techniques (such as the use of endoscopic submucosal dissection or full thickness resection device) are needed to treat recurrent polyp tissue

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  8. Need for surgical intervention to treat recurrent polyp

    Whether surgical intervention is needed to treat recurrent polyp tissue

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  9. Types of recurrences at follow-up

    Description of whether recurrence was visible during the follow-up procedure and confirmed by pathology, visible during the follow-up procedure but not confirmed by pathology, or not visible during the follow-up procedure but confirmed by pathology.

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  10. Techniques used to treat recurrent polyp

    The different techniques that were used to treat the recurrent polyp tissue.

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  11. Patient Survey Results

    Patient reported experience, including patient's comfort level with prolonged index surveillance, likelihood for returning for follow-up colonoscopy with extended interval, and other factors. This survey is multiple questions, and the responses will be reported on a 5-point Likert scale with 1 being very uncomfortable, not at all important, etc to 5 being very comfortable, very important, etc.

    Time frame: Typically 1 to 14 days after the large polyp removal procedure

  12. Adverse events that occur after the follow-up procedure

    The number of complications for each randomization arm during and after the follow-up procedure

    Time frame: 30 days after first surveillance colonoscopy

  13. Distance patient travelled to the endoscopy unit

    Calculation of the distance the patient travelled to the endoscopy unit as a surrogate for carbon impact

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

  14. Cost of equipment used at the resection site during the follow-up colonoscopy

    The cost of the equipment that was used at the resection site during the surveillance procedure

    Time frame: At first surveillance colonoscopy, typically 6 months to 12 months

07

Study locations

10 sites
08

References and documents

Publications

  • Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, Robertson DJ, Shaukat A, Syngal S, Rex DK. Endoscopic Removal of Colorectal Lesions-Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020 Mar;158(4):1095-1129. doi: 10.1053/j.gastro.2019.12.018. Epub 2020 Feb 11. No abstract available. PubMed 32122632 ↗
  • Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, Robertson DJ, Shaukat A, Syngal S, Rex DK. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020 Mar;158(4):1131-1153.e5. doi: 10.1053/j.gastro.2019.10.026. Epub 2020 Feb 7. No abstract available. PubMed 32044092 ↗
  • El Rahyel A, Abdullah N, Love E, Vemulapalli KC, Rex DK. Recurrence After Endoscopic Mucosal Resection: Early and Late Incidence, Treatment Outcomes, and Outcomes in Non-Overt (Histologic-Only) Recurrence. Gastroenterology. 2021 Feb;160(3):949-951.e2. doi: 10.1053/j.gastro.2020.10.039. Epub 2020 Oct 29. No abstract available. PubMed 33130101 ↗
  • Tate DJ, Desomer L, Argenziano ME, Mahajan N, Sidhu M, Vosko S, Shahidi N, Lee E, Williams SJ, Burgess NG, Bourke MJ. Treatment of adenoma recurrence after endoscopic mucosal resection. Gut. 2023 Oct;72(10):1875-1886. doi: 10.1136/gutjnl-2023-330300. Epub 2023 Jul 6. PubMed 37414440 ↗
  • Mohapatra S, Almazan E, Charilaou P, et al. Outcomes of Endoscopic Resection for Colorectal Polyps With High-Grade Dysplasia or Intramucosal Cancer. Techniques and Innovations in Gastrointestinal Endoscopy 2023;25:119-126.
  • Parsa N, Ponugoti P, Broadley H, Garcia J, Rex DK. Risk of cancer in 10 - 19 mm endoscopically detected colorectal lesions. Endoscopy. 2019 May;51(5):452-457. doi: 10.1055/a-0799-9997. Epub 2019 Jan 8. PubMed 30620947 ↗
  • McWhinney CD, Vemulapalli KC, El Rahyel A, Abdullah N, Rex DK. Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions >/=10 mm. Gastrointest Endosc. 2021 Mar;93(3):654-659. doi: 10.1016/j.gie.2020.08.032. Epub 2020 Sep 3. PubMed 32891621 ↗
  • Bobay MC, Lahr RE, Shultz J, Vemulapalli KC, Guardiola JJ, Rex DK. Safety of first surveillance colonoscopy at 12 months after piecemeal EMR of large nonpedunculated colorectal lesions. Gastrointest Endosc. 2024 Nov;100(5):905-913. doi: 10.1016/j.gie.2024.05.008. Epub 2024 May 14. PubMed 38750975 ↗
  • Lacroute J, Marcantoni J, Petitot S, Weber J, Levy P, Dirrenberger B, Tchoumak I, Baron M, Gibert S, Marguerite S, Huppertz J, Gronier O, Derlon A. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy. 2023 Oct;55(10):918-926. doi: 10.1055/a-2088-4062. Epub 2023 May 8. PubMed 37156511 ↗
  • Lopez-Munoz P, Martin-Cabezuelo R, Lorenzo-Zuniga V, Vilarino-Feltrer G, Tort-Ausina I, Vidaurre A, Pons Beltran V. Life cycle assessment of routinely used endoscopic instruments and simple intervention to reduce our environmental impact. Gut. 2023 Sep;72(9):1692-1697. doi: 10.1136/gutjnl-2023-329544. Epub 2023 Apr 26. PubMed 37185655 ↗
  • Belderbos TD, Leenders M, Moons LM, Siersema PD. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014 May;46(5):388-402. doi: 10.1055/s-0034-1364970. Epub 2014 Mar 26. PubMed 24671869 ↗
  • Pohl H, Rex DK, Barber J, Moyer MT, Elmunzer BJ, Rastogi A, Gordon SR, Zolotarevsky E, Levenick JM, Aslanian HR, Elatrache M, von Renteln D, Wallace MB, Brahmbhatt B, Keswani RN, Kumta NA, Pleskow DK, Smith ZL, Abu Ghanimeh MK, Simmer S, Sanaei O, Mackenzie TA, Piraka C. Cold snare endoscopic resection for large colon polyps: a randomised trial. Gut. 2025 Oct 8;74(11):1804-1813. doi: 10.1136/gutjnl-2025-335075. PubMed 40393701 ↗

Individual participant data

Plan to share: No — De-identified data may be shared in the future upon request per PI discretion.

09

Updates

1 registry update since Sep 25, 2026
Eligibility
1 exclusion criterion edited
What changed in the criteria
Exclusion criteria
  • EditedPatients with significant acute or chronic medical, neurologic, or illnessmedical problems that, in the judgment of the Principal Investigator, could compromise subject safety, limit the ability to complete the study, and/or compromise the objectives of the study per the judgement of the investigator.
Oct 21, 2026
Show all 1 update
  1. Oct 21, 2026
    Eligibility 1 exclusion criterion edited
    What changed in the criteria
    Exclusion criteria
    • EditedPatients with significant acute or chronic medical, neurologic, or illnessmedical problems that, in the judgment of the Principal Investigator, could compromise subject safety, limit the ability to complete the study, and/or compromise the objectives of the study per the judgement of the investigator.
    + 3 other changes: index terms, verification date and conditions

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT07198945
Lead sponsor
Indiana University
Responsible party
John J. Guardiola (Assistant Professor of Clinical Medicine, Indiana University) — Principal investigator
First posted
Sep 30, 2025
Start date
Jun 9, 2026
Primary completion
Dec 2029 (estimated)
Completion
Feb 2030 (estimated)
Last update
Oct 21, 2026

Study contacts

John J Guardiola, MD
principal investigator · Indiana University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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