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New European Postpolypectomy Surveillance Guideline

Guideline Watch |
December 19, 2013

New European Postpolypectomy Surveillance Guideline

  1. Douglas K. Rex, MD

A 10-year postpolypectomy surveillance interval is recommended in patients considered low-risk, in contrast with the 5-year interval commonly used in the U.S.

  1. Douglas K. Rex, MD

Sponsoring Organization: European Society of Gastrointestinal Endoscopy (ESGE)

Target Population: Gastroenterologists

Background and Objective

The ESGE has issued an evidence-based, consensus-based guideline on postpolypectomy endoscopic surveillance, including a comprehensive review of patient risk stratification after neoplastic polyp removal and practical recommendations for scheduling surveillance procedures. Major guidelines on this topic are already available from the U.S. Multi-Society Task Force (MSTF) on Colorectal Cancer and the British Society of Gastroenterology.

Key Recommendations

  • In low-risk patients (those with 1 to 2 tubular adenomas <10 mm in size), conduct surveillance colonoscopy 10 years after polypectomy.

  • In high-risk patients (those with adenoma ≥10 mm in size, ≥3 adenomas of which one is ≥10 mm, or villous histology or high-grade dysplasia), conduct surveillance colonoscopy at 3-year intervals, or at 5-year intervals if no high-risk adenomas are discovered at first follow-up colonoscopy.

  • Consider patients with sessile serrated polyps <10 mm with no dysplasia as low-risk and those with sessile serrated polyps ≥10 mm or dysplasia as high-risk.

Comment

This new guideline is very similar to that of the U.S. Multi-Society Task Force on Colorectal Cancer, except for the new guideline's longer recommended postpolypectomy screening interval in low-risk patients (10 years vs. 5–10 years in the MSTF guideline). In the U.S., most of these patients actually undergo a repeat colonoscopy at 5 years; very few clinicians recommend 10 years. In comparison with these two guidelines, the British guideline presents a broader risk stratification. In particular, it recommends that patients with ≥5 adenomas, or with ≥3 adenomas of which one is ≥10 mm, undergo colonoscopy 1 year later.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Exact Sciences; Ferring Pharmaceuticals; Given Imaging; Olympus Speaker’s bureau Boston Scientific; Braintree; Ferring Pharmaceuticals Grant / research support Battelle; Braintree; Northwestern University; Olympus America Editorial boards Annals of Gastroenterology and Hepatology; Comparative Effectiveness Research; Expert Review of Gastroenterology and Hepatology; Gastroenterology; Gastroenterology and Hepatology News; Gastroenterology Report; Gastroenterology Research and Practice; Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; World Journal of Gastroenterology; World Journal of Gastrointestinal Oncology; World Journal of Gastrointestinal Pathophysiology; World Journal of Gastrointestinal Pharmacology and Therapeutics

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