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Douglas K. Rex, MD, FASGE reviewing Rutter MD, et al. Gut 2019 Nov 27.

British societies have always had their own postpolypectomy guidelines. Previous recommendations (compared to the U.S. Multi-Society Task Force on Colorectal Cancer recommendations used in the U.S.) had both a special higher risk group, for which 1-year surveillance was recommended, and a larger low-risk group.

The new British guideline uses the following definitions:

  • The high-risk group requires 2 premalignant polyps of which ≥1 is advanced (a serrated polyp ≥10 mm or having dysplasia OR an adenoma ≥10 mm or with high-grade dysplasia) OR ≥5 premalignant polyps. 
  • “Premalignant” means any adenoma or serrated class polyp that is not a diminutive rectal hyperplastic polyp.

The key recommendations are:

  • Patients without high-risk findings should return to routine screening (which relies on fecal blood screening).
  • Patients with high-risk findings should have a “one-off” surveillance colonoscopy at 3 years.
  • Patients with a nonpedunculated lesion that is ≥20 mm and removed piecemeal should have a site check at 2 to 6 months and 1 year after that.
  • Surveillance should generally not occur if life expectancy is <10 years or in patients older than about 75 years.
  • An exception to the above is a patient who is >10 years younger than the lower recommended screening age who is found to have polyps but no high-risk criteria; follow-up colonoscopy in 5 or 10 years can be considered.

COMMENT
It’s interesting to see how other countries handle postpolypectomy surveillance, and this is a very radical revision of previous guidelines. The authors estimate that the new guidelines will reduce the colonoscopy surveillance workload to 20% of its current level. One of the interesting consequences is that resect and discard is fully enabled because adenomas <10 mm and sessile serrated lesions and hyperplastic polyps <10 mm (with the exception of 1- to 5-mm rectal hyperplastic polyps) are all considered equivalent in the guideline.

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)

Rutter MD, East J, Rees CJ, et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2019 Nov 27. (Epub ahead of print) (https://gut.bmj.com/content/69/2/201#block-system-main)

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