These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health ...England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia);
five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia);
five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise
:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia);
five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.
Colorectal cancer （CRC） is the third most commonlydiagnosed cancer worldwide. The identification ofcolonic polyps can reduce CRC mortality through earlierdiagnosis of cancers and the removal of ...polyps the precursor lesion of CRC. Following the finding andremoval of colonic polyps at an initial colonoscopy,some patients are at an increased risk of developingCRC in the future. This is the rationale for postpolypectomysurveillance colonoscopy. However, not allindividuals found to have colonic adenomas have a riskof CRC higher than that of the general population. Thisreview examines the literature on post-polypectomysurveillance including current international clinicalguidelines. The potential benefits of surveillanceprocedures must be weighed against the burden ofcolonoscopy： resource use, the potential for patientdiscomfort, and the risk of complications. Thereforesurveillance colonoscopy is best utilised in a selectedgroup of individuals at a high risk of developingcancer. Further study is needed into the specificfactors conferring higher risk as well as the efficacyof surveillance in mitigating this risk. Such evidencewill better inform clinicians and patients of the relativebenefits of colonoscopic surveillance for the individual.In addition, the decision to continue with surveillancemust be informed by the changing profile of risksand benefits of further procedures with the patient＇sadvancing age.
Improved colonoscopy quality has led to debate about whether all post-polypectomy surveillance is justified. We evaluated surveillance within the English Bowel Cancer Screening Programme (BCSP) to ...determine the yield of surveillance and identify predictive factors for surveillance outcome.
We performed a retrospective cohort study of individuals undergoing post-polypectomy surveillance between July 2006 and January 2017. BCSP records were linked to the National Cancer Registration Database to identify interval-type post-colonoscopy colorectal cancers (CRCs). Advanced adenoma and CRC at surveillance were documented. CRC incidence was compared with the general population using standardized incidence ratios (SIRs). Predictors of advanced adenomas at first surveillance (S1), and CRC during follow-up, were identified.
44 151 individuals (23 078 intermediate risk; 21 073 high risk) underwent 64 544 surveillance episodes. Advanced adenoma and CRC yields were, respectively, 10.0 % and 0.5 % at S1, 8.5 % and 0.4 % at S2, and 10.8 % and 0.4 % at S3. S1 yield was lowest in those with one index adenoma ≥ 10 mm (advanced adenoma 6.1 %; CRC 0.3 %). The SIR was 0.76 (95 %CI 0.66-0.88), accounted for by the intermediate risk group (intermediate risk SIR 0.61, 95 %CI 0.49-0.75; high risk SIR 0.95, 95 %CI 0.79-1.15). Adenoma multiplicity, presence of a large nonpedunculated adenoma, and greater villous component were associated with advanced adenoma at S1. Older age and multiplicity were significantly associated with CRC risk.
This large, national analysis found low levels of CRC in those undergoing surveillance and low advanced adenoma yield in most subgroups. Less intensive surveillance in some subgroups is warranted, and surveillance may be avoided in those with a single large adenoma.
Introduction Post-polypectomy surveillance by colonoscopy is recommended in national and international guidelines. While colonoscopy is the gold standard colorectal investigation, it carries a risk ...of adverse events as well as being inconvenient and often uncomfortable for the patient. It is established that population screening reduces mortality from colorectal cancer (CRC). The effect of post-polypectomy surveillance, however, is less clear. An increasing number of colonoscopies are being performed worldwide for both symptoms and screening. The adenoma detection rate at colonoscopy is also increasing with improved technology and training against the backdrop of an ageing population. As a result, an increasing number of individuals are entering post-polypectomy surveillance. Aims & Objectives The aim of the analysis was to evaluate the findings of post-polypectomy surveillance within the English Bowel Cancer Screening Programme (BCSP). This was done by assessing linked data from the BCSP database and the National Cancer Registration and Analysis Service (NCRAS). Objectives were: 1. To document surveillance pathways among the intermediate and high risk groups. 2. To determine the risk factors (adenoma and person-specific) at screening which predict the outcome of initial surveillance. 3. To determine the adenoma, advanced adenoma (AA) and CRC yield at initial surveillance of each colonoscopy surveillance cohort (and subcategories within each cohort) within the BCSP. Methods Data on individuals participating in the BCSP is entered prospectively onto the screening programme's relational database, BCSS. BCSS was interrogated for individuals who had attended for post-polypectomy surveillance at any time from the start of the programme in 2006 until the end of 2016. In addition, linked data on CRCs diagnosed in this cohort were obtained from NCRAS. Two separate analyses were performed. The first focussed on the detection of any AA (size ≥10mm or ≥25% villous or high-grade dysplasia) at the first surveillance attended by an individual. A separate analysis was performed with a diagnosis of CRC as the primary outcome. Results Of individuals with high risk findings at baseline colonoscopy, 12.3% of those attending first surveillance were found to have AA, 48.0% non-advanced adenoma, 39.1% no adenoma, and 0.5% CRC. In the case of individuals with intermediate risk findings at baseline, of those attending first surveillance, 8.0% were found to have AA, 35.3% non-advanced adenoma, 56.1% no adenoma, and 0.4% CRC. In those categorised as intermediate risk based on the finding of a single adenoma (≥10mm) at baseline, 6.3% of those attending first surveillance were found to have AA and 0.3% CRC. The most significant factor increasing the risk of AA at first surveillance was a higher total number of adenomas at baseline colonoscopy. Conclusions The rates of AA and CRC at first surveillance are relatively low and were found to be higher in the high risk group compared to intermediate risk. Those individuals categorised as intermediate risk based on a single adenoma (≥10mm) at baseline, had a particularly low rate of AA and CRC at first surveillance. These findings support the hypothesis that the incidence of AA and CRC are low at post-polypectomy surveillance colonoscopy. The particularly low yield in the subgroup with a single adenoma at baseline suggests that surveillance is not be needed in this group and may not be necessary for the intermediate risk cohort as a whole.
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