Follow-up intervals after polypectomy
Dr. med. Benjamin Walter, Universitätsklinikum Ulm
Colonoscopy is the most reliable procedure for detecting colorectal carcinomas and polyps. The aim of colonoscopy must be to achieve a polyp-free bowel (“clean colon”) — i.e., all relevant polyps should be completely removed. The histological assessment of the resected polyps should include not only the growth type, but also information about the completeness of the resection (R0).
In addition to the “classic adenoma–carcinoma sequence,” there are also other pathways for carcinoma development. On the one hand, there is what is known as the “serrated carcinogenesis pathway,” in which sessile serrated adenoma (SSA) is the entity regarded as a precursor lesion; on the other, there is also a “mixed type” that combines molecular characteristics of the two other carcinogenesis routes, with precursor lesions that may be either the traditional serrated adenoma (TSA) or villous adenomas.
“Interval carcinomas” are a problem. These are tumors that appear in the interval between two screening colonoscopies. Interval carcinomas are largely due to overlooked lesions (“missed adenomas”). Other factors may include incomplete polypectomy, lack of follow-up, and rapidly growing so-called “de novo” tumors.
The intervals set for follow-up examinations after a polypectomy depend on the patient’s individual risk. The risk is thus decisively dependent on the number, size, and histology of the adenomas that are removed.
Z Gastroenterol 2013; 51(8): 753-854 DOI: 10.1055/s-0033-1350264
Updated version: S3-Leitlinie Kolorektales Karzinom Langversion 2.1.–Januar 2019. AWMF-Registernummer: 021/007OL