Roel Bogie

Optimizing post-polypectomy surveillance: A practical guide for the endoscopist

Methods We conducted a systematic search in Pubmed and the Cochrane Library using questions that are relevant to surveillance practice ( Table 7.1 ). We retrieved key original studies, systematic reviews and meta-analyses (whenever available), up to March 1st, 2015. Specifically analyzed were general features and differences in recommended surveillance intervals across guidelines. Quality of bowel examination Intuitively, post-polypectomy surveillance can be initiated only after a high quality index colonoscopy. 1 The recent European Society of Gastrointestinal Endoscopy (ESGE) guidelines defines a high-quality colonoscopy as "a complete examination with a meticulous inspection of adequately cleaned colorectal mucosa, and at which all neoplasms detected have been completely removed and retrieved for histological examination." 1

Table 7.1: Search strategy | Results through March 2015.

Question

Search

Results

Outcome 18 relevant articles

How does quality of bowel preparation affect surveillance intervals?

‘colonoscopy’ combined with: ‘preparation’, ‘lavage’ and ‘cleaning’; ‘colon’, ‘bowel’ and ‘colorectal’; ‘efficiency’, ‘effectiveness’, ‘result’, ‘outcome’ and ‘polyp/adenoma detection rate’ ‘colonoscopy’, ‘colonoscopic’ and ‘colon endoscopy’ combined with: ‘surveillance’, ‘followup’ and ‘follow up’; ‘risk’, ‘post-polypectomy’ and ‘incidence’ ‘colonoscopy’, ‘colonoscopic’, ‘colon endoscopy’ combined with: ‘surveillance’, ‘followup’, ‘follow up’; and ‘post-polypectomy’, ‘postpolypectomy’; and ‘adenoma’, ‘carcinoma’, ‘advanced neoplasia’, ‘CRC’, ‘advanced adenoma’, ‘ADR’, ‘adenoma detection rate’ ‘colonoscopy’, ‘colonoscopic’, ‘colon endoscopy’ combined with: ‘EMR’, ‘endoscopic mucosal resection’, ‘removal’; and ‘adenoma’, ‘lesion’, ‘lesions’, ‘polyp’, ‘polyps’; and ‘follow up’, ‘followup’, ‘surveillance’; and ‘recurrence’, ‘residue’ ‘colonoscopy’, ‘coloscopy’ and ‘colon endoscopy’ combined with: ‘serrated polyps’, ‘serrated lesions’, ‘serrated adenomas’, ‘SSAP*’, ‘SSA/P*’, ‘SSA*’ and ‘SSP*’ ‘colonoscopy’, ‘coloscopy’ and ‘colon endoscopy’ combined with: ‘surveillance’, ‘follow-up’, ‘followup’; and ‘patient compliance’, ‘adherence’, ‘underuse’, ‘utilization’; with limit: ‘Humans’

570 results, 46 reviews

supplemented by 8 articles derived from references

7

How do findings at baseline colonoscopy influence surveillance intervals? Secondary question: What is the appropriate surveillance interval? Secondary question: What is the recurrence rate after endoscopic resection of colorectal polyps? Secondary question: What is the role of serrated lesions in determining surveillance intervals? How to improve adherence to surveillance recommendations?

7311 results, 77 meta analyses

3 relevant meta analyses included

85 results

7 relevant articles, 4 articles derived from references and guidelines

194 results, 15 reviews

4 recent, relevant articles (2 meta analyses), 11 key articles derived from references and guidelines 12 relevant articles, 3 key articles derived from references and guidelines

318 results, 49 reviews

978 results 8 relevant articles, 5 articles derived from references

131