Special report and reviewGuidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society
Section snippets
Methodology and Literature Review
We performed a Medline search of the postpolypectomy literature under the subject headings “colonoscopy” and “adenoma,” “polypectomy surveillance,” and “adenoma surveillance,” limited to English language articles from 1990 to 2005. This search identified 35 articles based on inclusion of data pertaining to baseline colonoscopy characteristics, advanced adenoma detection during follow-up surveillance, and advanced adenoma characteristics. Subsequently, we identified 12 additional articles from
Results of the Literature Review and Rationale for the Guidelines
Certain characteristics of colorectal adenomas at baseline colonoscopy are associated with the rate of adenoma detection and the histologic severity of subsequent adenomas. These data can be used as the basis for decisions about safe and effective postpolypectomy surveillance intervals by stratifying patients into lower-risk and higher-risk groups for future advanced adenomas. The available body of evidence is the basis for these recommendations.
Discussion
These guidelines are based on all of the available evidence, clinical experience, knowledge of the adenoma-carcinoma sequence, and expert opinion. They are intended to be used by clinicians as a guide in their approach to postpolypectomy surveillance, taking into consideration clinical judgment in patient comorbidities, patient preferences, and family history. The differences between these guidelines and prior ones are shown in Table 1. The detailed evidence for these guidelines are presented
Questions to Be Addressed
- 1
What are the reasons that guidelines are not followed more widely?
- 2
How can adherence to quality control indicators at baseline colonoscopy be encouraged to reduce the miss rate of advanced adenomas and colorectal cancers?
- 3
Will emerging studies with longer colonoscopy follow-up times support the safety of lengthening surveillance intervals?
- 4
What is the appropriate management and surveillance of the hyperplastic polyposis syndrome?
- 5
What is the appropriate surveillance of patients who have had an
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2023, Gastrointestinal EndoscopyCitation Excerpt :Prior research has identified multiple reasons for noncompliance with polyp surveillance guidelines, including the perception that a patient has risk factors not addressed by guidelines, fear of missed polyps or cancer, and questions about the strength of the underlying research.15-20 The latter 2 factors may be particularly relevant because the 2020 guidelines brought the first major change to LRA surveillance recommendations since 2003.14,21-23 Physicians tend to be risk-averse when following guidelines and may want further corroboration before adopting the updated LRA surveillance recommendations.24
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This article is being published jointly in 2006 in CA: A Cancer Journal for Clinicians (online: May 30, 2006; print: May/June 2006) and Gastroenterology (online: May 2006; print: May 2006) by the American Cancer Society and the American Gastroenterology Association. ©2006 American Cancer Society, Inc. and American Gastroenterology Association, Inc. Copying with attribution allowed for any noncommercial use of the work.