Roel Bogie

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

US Multi-Society Task Force on Colorectal Cancer Guidelines, 2012

European Society of Gastrointestinal Endoscopy Guidelines, 2013

10 years‡ Colonoscopy surveillance/ return to screening

Low

5-10 years

Low

Risk strati cation

Risk strati cation

3 years

High

3 years

High

Highest

<3 years

SSA/P†

SSA/P†

High grade dysplasia and villosity are considered independent risk factors

Common features ● High quality index colonoscopy

● Risk strati cation based on clinicopathologic phenotype ● Endoscopist responsibility for providing surveillance advice

Histologic features are not considered independent risk factors British Society of Gastroenterology and the Association of Coloproctology of Great Britain and Ireland Guidelines, 2010

Dutch Society of Gastroenterology Guidelines, 2013

10 years Screening

Low

5 years

Low

Risk strati cation

Risk strati cation

7

Intermediate

3 years

Intermediate

5 years

High

1 year

3 years

High

SSA/P†

Villosity and proximal location are considered independent risk factors

the UK versus the US guidelines in a pooled American population (four prospective studies) who underwent one year follow-up colonoscopy. The risk for advanced adenoma or CRC at one year after baseline colonoscopy was assessed using both US and UK stratification. The proportions of patients who were diagnosed with advanced adenomas or CRC at one year were 3.8% of the low risk and 11.2% of the high risk patients, when using the US guideline versus 4.4% of low risk, 9.9% of intermediate risk and 18.7% of high risk patients, when using the UK guideline. 55 Thus, surveillance colonoscopy after one year seems to be beneficial for the high-risk group, as defined by the UK criteria (12.1% of all patients) without a substantial increase in the overall rate of surveillance Figure 7.1: Common and specific features of some post-polypectomy surveillance guidelines. | United States Multi-Society Task Force on Colorectal Cancer post-polypectomy surveillance guidelines: 2 low risk, 1-2 tubular adenomas <10mm; high risk, 3-10 adenomas or ≥1 advanced adenoma; highest risk, >10 adenomas. European Society of Gastrointestinal Endoscopy post-polypectomy surveillance guidelines: 1 low risk, 1-2 tubular adenomas <10mm; high risk, ≥3 adenomas or ≥1 advanced adenoma. British Society of Gastroenterology and the Association Coloproctology of Great Britain and Ireland post-polypectomy surveillance guidelines: 3 low risk, 1-2 adenomas <10mm; intermediate risk, 3-4 adenomas <10mm or ≥1 ≥10mm; high risk, ≥5 small adenomas or ≥3 adenomas with ≥1 ≥10mm. Revised Dutch Society of Gastroenterology post-polypectomy surveillance guidelines: 7 low risk, score 0 (no or 1 non-advanced distal adenoma); intermediate risk, score 1-2; high risk, score 3-5. †Presence of SSA/P included in determining surveillance intervals, ‡Follow-up colonoscopy or return to screening program (if available) after 10 years.

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