Recommendations updated on surveillance after colonoscopy and polypectomy

A multispecialty task force recently updated its recommendations for follow-up after colonoscopy and polypectomy.

The U.S. Multi-Society Task Force on Colorectal Cancer, with representatives of the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy, had last issued recommendations on the topic in 2012. The new consensus update noted that since then, a number of articles have provided new data on the risk of colorectal cancer based on colonoscopy findings and patient characteristics, as well as on outcomes of screening and surveillance colonoscopy. Colonoscopy technology and quality efforts have also been improving, the task force said.

The full recommendations were published in the American Journal of Gastroenterology, Gastroenterology, and Gastrointestinal Endoscopy on Feb. 7.

The authors highlighted the following key updates from their 2012 recommendations:

• New evidence based on risk of colorectal cancer outcomes, rather than based only on risk of advanced adenoma during surveillance, strengthened polyp-surveillance recommendations.
• Seven- to 10-year rather than five- to 10-year follow-up is recommended after removal of one or two tubular adenomas less than 10 mm in size.
• More detailed recommendations were provided for follow-up after removal of serrated polyps.
• The importance of high-quality baseline examination was emphasized.
• One-year follow-up rather than less than three years of follow-up is recommended after removal of more than 10 adenomas.
• Three- to five-year follow-up may be recommended instead of three-year follow-up after removal of three or four adenomas less than 10 mm in size.

The task force observed that colorectal cancer “incidence and mortality are decreasing secondary to improvements in risk factor exposures, screening, treatment, and perhaps exposure to surveillance among patients with polyp.” It added that surveillance colonoscopy for patients with risk factors is clinically rational and recommended. “Evidence to support best practices for surveillance colonoscopy has strengthened and has helped to support close follow-up for some groups, as well as less intense follow-up for others. More work is needed to fully understand which patient populations are most likely to benefit from surveillance, and the ideal surveillance interventions to apply for optimizing [colorectal cancer] prevention and early detection,” the update concluded.