COMMENTARY

Top 10 Practice-Changing Articles of 2012: Gastroenterology

David A. Johnson, MD

Disclosures

January 16, 2013

In This Article

Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Lieberman DA , Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR
Gastroenterology. 2012;143:844-857

Abstract

Updated Postpolypectomy Guidelines

This is the postpolypectomy guideline update from the US Multi-Society Task Force on Colorectal Cancer. There are 2 notable changes from the last guideline published in 2006. First, the recommendation now states that surveillance intervals should be based on results not only from the patient's most recent colonoscopy but also from a previous colonoscopy that identified neoplasia. Accordingly, patients who had low-risk adenoma (1 or 2 tubular adenomas < 1 cm in size) at baseline colonoscopy and no subsequent adenomas detected during the first surveillance examination at 5 years should be returned to the average-risk screening population and have the next surveillance examination at 10 years. In contrast, patients who had baseline high-risk adenomas (including an advanced adenoma or ≥ 3 adenomas) detected at baseline colonoscopy and then had no subsequent adenomas detected at first surveillance examination should continue to undergo surveillance examinations at 5-year intervals.

Second are new guidelines on surveillance intervals after resection of serrated lesions:

  • A small sessile serrated polyp (<10 mm) with no dysplasia: repeat colonoscopy in 5 years.

  • A sessile serrated polyp (≥ 10 mm), a sessile serrated polyp with dysplasia, or a traditional serrated adenoma: repeat colonoscopy in 3 years.

  • Serrated polyposis syndrome: repeat colonoscopy in 1 year, although subsequent examinations that identify a decreasing polyp burden can be followed by longer intervals.

Viewpoint

These surveillance guidelines expand previous recommendations and will be used by those who evaluate quality of performance for colonoscopy.

processing....