Based on newly available evidence and expert consensus, the US Multi-Society Task Force released updated recommendations for postcolonoscopy management strategies and polyp surveillance. Recommended intervals for screening and surveillance colonoscopy are based on risk stratification for incident and fatal colorectal cancer. This report was published in Gastrointestinal Endoscopy.
The investigators performed a systematic review of recent studies focused on quality factors and utilization of state-of-the-art colonoscopy technologies published between January 2012 and September 2018. Recommendations were developed by the task force, in which they identified key issues, established PICO (patient, intervention comparison, and outcome) questions, and reached consensus.
Recommendations for Postcolonoscopy Surveillance Strategies
Based on evidence, patients with normal, high-quality colonoscopy are at lower risk of developing colorectal cancer; the task force recommends repeat screening for colorectal cancer in 10 years for these individuals.
The task force suggests that patients who have had 1 to 2 tubular adenomas <10 mm removed during high-quality baseline examination are at low risk for incident colorectal cancer, and repeat colonoscopy is recommended within a range of 7 to 10 years.
Patients who have had 3 to 4 tubular adenomas <10 mm removed during baseline colonoscopy should repeat screening in 3 to 5 years, as suggested by the task force; patients who have had 5 to 10 tubular adenomas <10 mm removed should repeat colonoscopy within 3 years.
For patients who have had 1 or more adenoma ≥10 mm removed during baseline examination, the task force recommends repeat colonoscopy within 3 years.
The task force recommends repeat colonoscopy in 3 years for patients who have had a baseline adenoma containing villous histology removed, as villous histology is a potential risk factor for advanced neoplasia on follow-up. Similarly, patients who have had an adenoma containing high-grade dysplasia removed should repeat colonoscopy in 3 years.
Patients who have had over 10 adenomas removed during a high-quality examination are at increased risk for hereditary polyposis syndrome and repeat colonoscopy is recommended within 1 year.
The task force recommends repeat colonoscopy in 10 years for patients who have had 20 or more hyperplastic polyps <10 mm in size removed from the rectum or sigmoid colon (or proximal to the sigmoid colon) as no new evidence supports an association between small rectosigmoid hyperplastic polyps and risk for advanced neoplasia.
For patients who have had hyperplastic polyps ≥10 mm removed during examination, repeat colonoscopy is recommended within a range of 3 to 5 years. The recommended follow-up interval depends on the pathologist consistency in distinguishing hyperplastic polyps from sessile serrated polyps, quality of bowel preparation, or confidence of complete polyp excision; if these factors are high, the task force recommends repeat colonoscopy in 5 years, and if they are adequate or low, the task force recommends repeat colonoscopy in 3 years.
Sessile Serrated Polyps
Although evidence is low, patients with baseline sessile serrated polyps appear to be at increased risk of developing large metachronous polyps. For patients who have had 1 to 2 sessile serrated polyps <10 mm removed at a baseline colonoscopy, repeat colorectal cancer screening is recommended within a range of 5 to 10 years.
The task force recommends patients who have had 3 to 4 sessile serrated polyps <10 mm removed during baseline colonoscopy to repeat screening in 3 to 5 years; patients who have had 5 to 10 sessile serrated polyps <10 mm removed at a high-quality examination should schedule a repeat colonoscopy within 3 years.
Patients who have had any serrated polyp ≥10mm removed at a high-quality examination are at risk of developing large serrated polyps, and the task force recommends repeat colonoscopy within 3 years for these individuals.
In adjusted analyses, traditional serrated adenomas were associated with higher risk for advanced neoplasia; patients who have had a traditional serrated adenoma removed at high-quality colonoscopy are recommended for follow-up examination within 3 years.
Although rare, patients with sessile serrated polyps containing dysplasia at baseline examination are also recommended for repeat colonoscopy in 3 years; however, there is a lack of evidence regarding metachronous neoplasia risk when comparing patients with sessile serrated polyps with or without dysplasia.
For patients who have had baseline adenoma removal and a follow-up colonoscopy, the task force recommends that subsequent surveillance should take into account any findings reported both at baseline and follow-up examinations.
The task force recommends against use of currently published prediction models for polyp surveillance recommendations. Although multiple models have been developed and are promising, their incremental value over current risk-stratification recommendations are unclear and require external validation.
For patients having at least 1 proximal adenoma, the task force also recommends against differential management strategies. Currently, there is insufficient evidence to determine whether proximal adenoma location is a factor associated with risk for advanced adenoma at follow-up.
Piecemeal adenoma resection and sessile serrated polyps larger than 20 mm are associated with high risk for recurrent neoplasia. Patients with large polyps resected in piecemeal fashion are recommended for repeat colonoscopy within 6 months; second surveillance is recommended 1 year after the first follow-up screening, and third surveillance is recommended 3 years after the second surveillance.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please refer to the original reference for a full list of authors’ disclosures.
Gupta S, Lieberman D, Anderson JC, et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer [published online February 3, 2020]. Gastrointest Endosc. doi:10.1016/j.gie.2020.01.014