Updated Postpolypectomy Surveillance Recommendations of the Multi-Society Task Force
Douglas K. Rex, MD, FASGE, reviewing Gupta S, et al. Gastroenterology 2020 Feb 7.
The U.S. Multi-Society Task Force on Colorectal Cancer has updated its recommendations for postpolypectomy surveillance. This is the first update since 2012.
Key recommendations in the update include:
- The recommendations assume adequate bowel preparation and performance of a high-quality baseline colonoscopy by an endoscopist with an adenoma detection rate (ADR) above recommended thresholds.
- Postpolypectomy surveillance intervals should be based on the following criteria:
- Patients with 1 or 2 tubular adenomas sized <10 mm: 7 to 10 years.
- Patients with 3 or 4 tubular adenomas <10 mm: 3 to 5 years.
- Those with 5 to 10 tubular adenomas <10 mm: 3 years.
- Patients with >10 adenomas on a single exam: 1 year.
- Those with 1 or 2 sessile serrated polyps (SSPs) <10 mm: 5 to 10 years.
- Patients with hyperplastic polyps ≥10 mm: 3 to 5 years.
- Those with advanced adenomas, SSPs ≥10 mm, dysplastic SSPs, or traditional serrated adenomas: 3 years.
- Patients who underwent piecemeal resection of an adenoma or SSP ≥20 mm: 6 months.
COMMENT
These recommendations are slightly more complex than previous ones, reflecting an evidence base that has grown in complexity.The most significant change is the move to 7 to 10 years for the group with 1 or 2 tubular adenomas <10 mm, which was 5 to 10 years in the last version. This group constitutes about two-thirds of the adenoma-bearing cohort. Considerable evidence suggests that the right interval for this group is 10 years. However, the interval of 7 to 10 years allows flexibility because, in recent studies, this cohort had a similar risk of cancer as the group with no adenomas, but the cohort was exposed to more surveillance colonoscopy.
The group with 1 or 2 small SSPs <10 mm retains a 5- to 10-year interval because the evidence base to support expansion of the interval is more limited.
Combined with improvement in colonoscopy detection, these guidelines represent an important advance in improving the cost effectiveness of colonoscopy practice.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
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. Gastroenterology 2020 Feb 7. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.01.014)
