Materiały źródłowe

• #1 Colonic Polyps: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/172674-overview

  Population and autopsy studies suggest that about 30% of middle-aged or elderly individuals have colonic polyps. In comparison, the incidence of familial adenomatous polyposis (FAP) in the United States is one case for every 6580-8300 persons. […] Accurate comparison of colonic polyp incidence and prevalence among countries is difficult because of the differences in the methods used for detection. Colonic polyp prevalence in patients older than 60 years appears to vary substantially within and among countries, but it appears to be greater than 10% in most areas. […] Race per se is not a major risk factor for colonic polyps. However, studies indicate that black individuals have a somewhat higher incidence and an earlier onset of colorectal carcinoma. Task force guidelines from the US Multi-Society Task Force on Colorectal Cancer as well as those from the American Gastroenterological Association (AGA) recommend beginning colorectal cancer screening in black persons at age 45 years, rather than the standard age of 50 years.

• #2 Colonic Polyps: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/172674-overview

  Males appear to have a moderately higher colonic polyp incidence than females, with earlier onset observed in some studies. […] Colonic polyps are strongly associated with increasing age (typically after age 40 y), but they can occur early in patients with polyposis syndromes. For example, colonic polyps can be detected in adolescents with familial adenomatous polyposis and in patients aged 20-40 years with hereditary nonpolyposis colorectal cancer (HNPCC).

• #3 Surveillance guidelines after removal of colorectal adenomatous polyps | Gut

  https://gut.bmj.com/content/51/suppl_5/v6

  Postmortem and screening colonoscopy studies estimate the prevalence of colonic adenomas to be 30%-40% at age 60 years, however the lifetime cumulative incidence of CRC is 5.5% therefore many colonic adenomas do not progress to cancer. […] The development of invasive cancer from a small (10 mm) adenoma is unlikely in less than five years. […] The rationale for colonoscopic surveillance has always been based on the high detection rate of colorectal adenomas at follow up (30%-50%) after a complete clearance colonoscopy. […] However, the main object of colonoscopic surveillance is the prevention of subsequent colorectal cancer rather than the detection and removal of adenomas, most of which will not become malignant. […] Adenomas with advanced pathology (1 cm, with villous elements or severe dysplasia) have a much higher malignant potential and the object of screening is to ensure that such lesions are detected before they become invasive.

• #4 Colonic Polyps: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/172674-overview

  Population and autopsy studies suggest that about 30% of middle-aged or elderly individuals have colonic polyps. In comparison, the incidence of familial adenomatous polyposis (FAP) in the United States is one case for every 6580-8300 persons. […] Accurate comparison of colonic polyp incidence and prevalence among countries is difficult because of the differences in the methods used for detection. Colonic polyp prevalence in patients older than 60 years appears to vary substantially within and among countries, but it appears to be greater than 10% in most areas. […] Race per se is not a major risk factor for colonic polyps. However, studies indicate that black individuals have a somewhat higher incidence and an earlier onset of colorectal carcinoma. Task force guidelines from the US Multi-Society Task Force on Colorectal Cancer as well as those from the American Gastroenterological Association (AGA) recommend beginning colorectal cancer screening in black persons at age 45 years, rather than the standard age of 50 years.

• #5 Prevalence of diverse colorectal polyps and risk factors for colorectal carcinoma in situ and neoplastic polyps | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-024-05111-z

  Most colorectal cancers originate from precancerous polyps. This study aimed to determine the prevalence of colorectal polyps with diverse pathological morphologies and to explore the risk factors for colorectal carcinoma in situ (CCS) and neoplastic polyps. […] In total, 2329 individuals with 3550 polyps were recruited. Among all patients, 76.99% had neoplastic polyps and 44.31% had advanced adenomas. […] The prevalence of CCS was 3.86%. […] More than 3/4 of colorectal polyp patients have neoplastic polyps. Patients are more inclined to develop CCS and neoplastic polyps if they have large polyps (1.0 cm) or multifocal polyps. […] The current research tends to study the mechanism of colorectal polyps in colorectal cancer and the relevant factors of neoplastic polyps. […] The purpose of this study was to first assess the prevalence of colorectal polyps with diverse pathological morphologies, then investigate the effects of demographic data, metabolic disease and hematological indicators on CCS and neoplastic polyps, and finally identify the risk factors for the development of CCS and neoplastic polyps.

• #6 Prevalence and risk factors for colorectal polyps in a Chinese population: a retrospective study | Scientific Reports

  https://www.nature.com/articles/s41598-020-63827-6

  The incidence of colorectal polyps is rising. Certain types of polyps are considered to be the precursor lesions for colorectal cancers. […] The prevalence of colorectal polyps was 18.1%. […] Regular smoking was independently associated with the presence and development of colorectal polyps. […] Smoking tends to be more relevant to rectal, small and single polyp. […] Exploring the epidemiology and risk factors may improve the prevention of colorectal polyps, even colorectal cancer. […] The incidence of colorectal polyp is rapidly increasing worldwide. […] Smoking is proposed to be closely associated with colorectal polyps, neoplasia, and CRCs. […] The retrospective cohort study revealed that the cumulative incidence of subjects developed colorectal polyps was 19.1% during their follow-up colonoscopy surveillance.

• #7 Colon polyps epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Colon_polyps_epidemiology_and_demographics

  The exact incidence and prevalence of colon polyps are unknown. Colon polyps are incidentally found in colonoscopies and sigmoidoscopies. However, the incidence of colon polyps is estimated to be 200,000 cases in the united states annually. The prevalence of colon polyps is between 10,000-25,000 in 100,000 screening studies. The incidence of colon polyps increases with age; the median age at diagnosis is 50 years. Colon polyps usually affect individuals of the African American race. Men are more commonly affected by colon polyps than women. Colon polyps is a common disease worldwide. […] The incidence of colon polyps is estimated to be 200,000 cases in the united states annually. […] The cumulative incidence of polyps in 3 years after normal flexible sigmoidoscopy is 7%. […] The cumulative incidence of polyps in 3 years after normal colonoscopy is 27%.

• #8 Colonic Polyps: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/172674-overview

  Males appear to have a moderately higher colonic polyp incidence than females, with earlier onset observed in some studies. […] Colonic polyps are strongly associated with increasing age (typically after age 40 y), but they can occur early in patients with polyposis syndromes. For example, colonic polyps can be detected in adolescents with familial adenomatous polyposis and in patients aged 20-40 years with hereditary nonpolyposis colorectal cancer (HNPCC).

• #9 Colon polyps epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Colon_polyps_epidemiology_and_demographics

  The prevalence of colon polyps is 10,000 in 100,000 sigmoidoscopy studies. […] The prevalence of colon polyps is 25,000 in 100,000 colonoscopy studies. […] The prevalence of hyperplastic colon polyps in autopsy studies is between 7,000-40,000 in 100,000 in individuals younger than 50 years of age. […] The prevalence of hyperplastic colon polyps in autopsy studies is between 20,000-40,000 in individuals older than 50 years of age. […] The incidence of colon polyps increases with age; the median age at diagnosis is 50 years. […] Colon polyps commonly affects individuals older than 50 years of age. […] Colon polyps usually affect individuals of the African American race. […] Men are more commonly affected by colon polyps than women. […] Colon polyps is a common disease worldwide.

• #10 Colonic Polyps: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/172674-overview

  Population and autopsy studies suggest that about 30% of middle-aged or elderly individuals have colonic polyps. In comparison, the incidence of familial adenomatous polyposis (FAP) in the United States is one case for every 6580-8300 persons. […] Accurate comparison of colonic polyp incidence and prevalence among countries is difficult because of the differences in the methods used for detection. Colonic polyp prevalence in patients older than 60 years appears to vary substantially within and among countries, but it appears to be greater than 10% in most areas. […] Race per se is not a major risk factor for colonic polyps. However, studies indicate that black individuals have a somewhat higher incidence and an earlier onset of colorectal carcinoma. Task force guidelines from the US Multi-Society Task Force on Colorectal Cancer as well as those from the American Gastroenterological Association (AGA) recommend beginning colorectal cancer screening in black persons at age 45 years, rather than the standard age of 50 years.

• #11 Prevalence of diverse colorectal polyps and risk factors for colorectal carcinoma in situ and neoplastic polyps | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-024-05111-z

  The study showed that the incidence of colorectal cancer in the polyp group was greater than that in the control group except for hyperplastic polyps. […] The progression from adenoma to colorectal cancer is a lengthy, multistep process involving the accumulation of driver mutations. […] The findings revealed that individuals with CCS had significantly greater median CA724 levels than did those with noncarcinoma in situ. […] The results showed that age, diameter1.0 cm, number of polyps3, schistosome egg deposition, CA724, and CA211 level were risk factors for colorectal carcinoma in situ, while the serum albumin concentration was a protective factor. […] This study showed that for each 1-year increase in age, the risk of neoplastic polyps increased by 3%. […] The risk of CCS in patients with a colorectal polyp diameter1.0 cm was 8.07 times greater than that in patients with a diameter1.0 cm.

• #12 Prevalence and risk factors for colorectal polyps in a Chinese population: a retrospective study | Scientific Reports

  https://www.nature.com/articles/s41598-020-63827-6

  The incidence of colorectal polyps is rising. Certain types of polyps are considered to be the precursor lesions for colorectal cancers. […] The prevalence of colorectal polyps was 18.1%. […] Regular smoking was independently associated with the presence and development of colorectal polyps. […] Smoking tends to be more relevant to rectal, small and single polyp. […] Exploring the epidemiology and risk factors may improve the prevention of colorectal polyps, even colorectal cancer. […] The incidence of colorectal polyp is rapidly increasing worldwide. […] Smoking is proposed to be closely associated with colorectal polyps, neoplasia, and CRCs. […] The retrospective cohort study revealed that the cumulative incidence of subjects developed colorectal polyps was 19.1% during their follow-up colonoscopy surveillance.

• #13 Prevalence and risk factors for colorectal polyps in a Chinese population: a retrospective study | Scientific Reports

  https://www.nature.com/articles/s41598-020-63827-6

  Regular cigarette smoking and albumin were independent risk factors for the development of colorectal polyps. […] Further analyses showed those who were current smokers, had more daily smoking consumption, and combined with regular drinking had a higher risk of developing colorectal polyps. […] The current study also demonstrated that regular tobacco consumption tends to cause rectal, small and single polyps. […] In summary, our study indicated that colorectal polyps are prevalent in China, and nearly one-fifth subjects developed polyps during the study period. Smoking was significantly associated with the presence and development of polyps, especially related to the rectal, small and single polyp.

• #14

  https://link.springer.com/article/10.1007/s10151-004-0169-y

  The prevalence of colorectal adenomatous polyps varies widely from country to country. Among asymptomatic, average-risk patients, adenoma prevalence averages approximately 10% in sigmoidoscopy studies and more than 25% in colonoscopy studies, whereas the prevalence of colorectal cancer among these patients is less than 1%. […] The cumulative incidence of new adenomas within 3 years after normal endoscopy averages about 7% by flexible sigmoidoscopy and 27% by colonoscopy. […] As far as risk factors for colorectal adenomas are concerned, several data are now available on the potential role of various diet items. Tobacco smoking may be important in the early stages of adenoma formation, but not necessarily in the later stages. Alcohol consumption elevates the risk of adenomatous colorectal polyps and this seems increased by ADH3 polymorphism. Another gene-environment relationship of interest in colorectal tumorigenesis may be based on folates effects on K-ras mutations.

• #15 Prevalence of diverse colorectal polyps and risk factors for colorectal carcinoma in situ and neoplastic polyps | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-024-05111-z

  The study showed that the incidence of colorectal cancer in the polyp group was greater than that in the control group except for hyperplastic polyps. […] The progression from adenoma to colorectal cancer is a lengthy, multistep process involving the accumulation of driver mutations. […] The findings revealed that individuals with CCS had significantly greater median CA724 levels than did those with noncarcinoma in situ. […] The results showed that age, diameter1.0 cm, number of polyps3, schistosome egg deposition, CA724, and CA211 level were risk factors for colorectal carcinoma in situ, while the serum albumin concentration was a protective factor. […] This study showed that for each 1-year increase in age, the risk of neoplastic polyps increased by 3%. […] The risk of CCS in patients with a colorectal polyp diameter1.0 cm was 8.07 times greater than that in patients with a diameter1.0 cm.

• #16 Prevalence of diverse colorectal polyps and risk factors for colorectal carcinoma in situ and neoplastic polyps | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-024-05111-z

  The study showed that the incidence of colorectal cancer in the polyp group was greater than that in the control group except for hyperplastic polyps. […] The progression from adenoma to colorectal cancer is a lengthy, multistep process involving the accumulation of driver mutations. […] The findings revealed that individuals with CCS had significantly greater median CA724 levels than did those with noncarcinoma in situ. […] The results showed that age, diameter1.0 cm, number of polyps3, schistosome egg deposition, CA724, and CA211 level were risk factors for colorectal carcinoma in situ, while the serum albumin concentration was a protective factor. […] This study showed that for each 1-year increase in age, the risk of neoplastic polyps increased by 3%. […] The risk of CCS in patients with a colorectal polyp diameter1.0 cm was 8.07 times greater than that in patients with a diameter1.0 cm.

• #17 Colorectal Cancer Risk Factors | Hereditary Colorectal Risk Factors | American Cancer Society

  https://www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html

  If you survived cancer in the past and as part of your treatment, received radiation to the area where your colon is (abdomen and pelvis area), your risk of colorectal cancer is increased. […] Most colorectal cancers are found in people without a family history of colorectal cancer. Still, as many as 1 in 3 people who develop colorectal cancer have other family members who have had it. […] About 5% of people who develop colorectal cancer have inherited gene changes (mutations) that cause family cancer syndromes and can lead to them getting the disease. […] The most common inherited syndromes linked with colorectal cancers are Lynch syndrome (hereditary non-polyposis colorectal cancer, or HNPCC) and familial adenomatous polyposis (FAP), but other rarer syndromes can increase colorectal cancer risk, too.

• #18 Colorectal Cancer Risk Factors | Hereditary Colorectal Risk Factors | American Cancer Society

  https://www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html

  Researchers have found several risk factors that might increase a persons chance of developing colorectal polyps or colorectal cancer. […] Many lifestyle-related factors have been linked to colorectal cancer. In fact, more than half of all colorectal cancers are linked to risk factors that can be changed. […] People who have smoked tobacco for a long time are more likely to develop and die from colorectal cancer than people who don’t smoke. Smoking tobacco also increases the risk for people to develop colon polyps. […] If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large, if there are many of them, or if any of them show dysplasia. […] If you have inflammatory bowel disease (IBD), including either ulcerative colitis or Crohns disease, your risk of colorectal cancer is increased.

• #19 Surveillance of colonic polyps: Are we getting it right?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4726668/

  Individuals found to have colonic polyps are at increased risk of advanced neoplasia in the future. This risk may be due to a number of mechanisms: (1) Missed lesions at the initial colonoscopy; (2) Incomplete removal of adenomatous tissue at initial colonoscopy; and (3) The individuals propensity to colonic neoplasia (either lifestyle factors, an inherent imbalance of cell proliferation, or a combination of these). […] Although the risk of developing further adenomas is known, no randomised study has directly assessed the effect of post-polypectomy surveillance on CRC incidence or mortality. The efficacy of surveillance has been assessed by retrospective epidemiological series indicating that patients not entered into a surveillance programme have three- to fourfold greater risk of CRC. However, the increased risk pertains to those found to have advanced adenomas at the index procedure. Individuals with non-advanced adenomas did not have significantly higher risk than the general population.

• #20 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

  https://gut.bmj.com/content/69/2/201

  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. […] The high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either: two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10mm in size or containing any grade of dysplasia, or an adenoma of at least 10mm in size or containing high-grade dysplasia); or five or more premalignant polyps. […] The primary aim of post-polypectomy and post-CRC resection surveillance is to reduce CRC incidence in patients found to have prior colonic neoplasia, once neoplasia clearance has been achieved. This is achieved through the subsequent identification and resection of de novo and missed polyps, thereby preventing these lesions from progressing to CRC.

• #21 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

  https://gut.bmj.com/content/69/2/201

  Surveillance should only be offered to individuals who remain at higher risk of developing CRC, beyond the reduction seen by index polyp clearance, as compared with the general population. […] The effectiveness of post-polypectomy surveillance is best determined by comparing the long-term CRC risk of a defined cohort of post-polypectomy patients undergoing surveillance with that of an age- and sex-matched general population comparator group. […] The need for post-polypectomy surveillance is best determined by comparing the long-term CRC risk of a defined cohort of post-polypectomy patients not undergoing surveillance with that of an age- and sex-matched general population comparator group. […] The guidelines incorporate surveillance of patients following resection of either adenomatous or serrated polyps, aiming to simplify risk stratification of patients who may have both types of polyp. […] The guidelines do not address surveillance in patients affected by hereditary colorectal syndromes, guidelines for which have also been updated recently.

• #22 Colonic Polyps: Diagnosis and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6878826/

  Colorectal (CR) screening for polyp diagnosis and removal can decrease the incidence of, and reduce mortality from, CRC. […] Given the benefits and effectiveness of screening, guidelines exist from multiple organizations. These guidelines risk-stratify patients based on several factors, including age, family history, and other comorbidities and can provide an approach for initiation of screening and continued surveillance. […] CR screening recommendations are based on an individual’s risk of developing and accumulating premalignant polyps. Risk stratification depends on the age when CR polyps begin to develop and the interval at which polyps may grow. All national screening guidelines (American Cancer Society [ACS]; United States Multi-Specialty Task Force [MSTF]; American College of Radiology [ACR]; United States Preventive Services Task Force [USPSTF]) stratify patients into three levels of risk: average risk, increased risk, and high risk.

• #23 Colonic Polyps: Diagnosis and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6878826/

  Colorectal (CR) screening for polyp diagnosis and removal can decrease the incidence of, and reduce mortality from, CRC. […] Given the benefits and effectiveness of screening, guidelines exist from multiple organizations. These guidelines risk-stratify patients based on several factors, including age, family history, and other comorbidities and can provide an approach for initiation of screening and continued surveillance. […] CR screening recommendations are based on an individual’s risk of developing and accumulating premalignant polyps. Risk stratification depends on the age when CR polyps begin to develop and the interval at which polyps may grow. All national screening guidelines (American Cancer Society [ACS]; United States Multi-Specialty Task Force [MSTF]; American College of Radiology [ACR]; United States Preventive Services Task Force [USPSTF]) stratify patients into three levels of risk: average risk, increased risk, and high risk.

• #24 Polyp & Colonoscopy Surveillance Guidelines: BSG/ACPGBI/PHE

  https://www.bsg.org.uk/clinical-resource/list-of-recommendations

  These guidelines have been reviewed and endorsed by BSG CSSC and ACPGBI, and have now been published in Gut: Rutter MD, East J, Rees CJ, et al. Gut 2020;69:201–223. […] They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 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. […] The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise EITHER: 2 or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10mm in size or containing any grade of dysplasia, or an adenoma of at least 10mm in size or containing high-grade dysplasia); OR 5 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.

• #25 Colonoscopy surveillance after colon (colonic) polyp (polyps) – Primary Care Notebook

  https://primarycarenotebook.com/pages/gastroenterology/colonoscopy-surveillance-after-colon-colonic-polyp-polyps

  Consensus guidelines have been developed by the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland and Public Health England. Key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise EITHER: 2 or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10mm in size or containing any grade of dysplasia, or an adenoma of at least 10mm in size or containing high-grade dysplasia); OR 5 or more premalignant polyps. […] A study found that stool-based post-polypectomy surveillance strategies (microsimulation modelling using annual FIT-based surveillance with FOB-gold at a threshold 32 g/g faeces) can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.

• #26 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  This document is based on recent evidence regarding the effect of screening and surveillance on incident colorectal cancer (CRC) and polyp risk, in the era of heightened focus on the importance of high-quality colonoscopy and broader use of technological advances. […] Recommendations assume high-quality baseline colonoscopy, defined as complete examination to the cecum, adequate bowel preparation, performance by a colonoscopist with adequate adenoma detection rate, and attention to complete polyp excision. […] Individuals with normal colonoscopy, or with <20 hyperplastic polyps <10 mm, should undergo surveillance in 10 years. [...] Individuals with 1–2 adenomas <10 mm should undergo surveillance colonoscopy in 7–10 years. In those with 3–4 adenomas <10 mm, surveillance should occur in 3–5 years.

• #27 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  This document is based on recent evidence regarding the effect of screening and surveillance on incident colorectal cancer (CRC) and polyp risk, in the era of heightened focus on the importance of high-quality colonoscopy and broader use of technological advances. […] Recommendations assume high-quality baseline colonoscopy, defined as complete examination to the cecum, adequate bowel preparation, performance by a colonoscopist with adequate adenoma detection rate, and attention to complete polyp excision. […] Individuals with normal colonoscopy, or with <20 hyperplastic polyps <10 mm, should undergo surveillance in 10 years. [...] Individuals with 1–2 adenomas <10 mm should undergo surveillance colonoscopy in 7–10 years. In those with 3–4 adenomas <10 mm, surveillance should occur in 3–5 years.

• #28 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  This document is based on recent evidence regarding the effect of screening and surveillance on incident colorectal cancer (CRC) and polyp risk, in the era of heightened focus on the importance of high-quality colonoscopy and broader use of technological advances. […] Recommendations assume high-quality baseline colonoscopy, defined as complete examination to the cecum, adequate bowel preparation, performance by a colonoscopist with adequate adenoma detection rate, and attention to complete polyp excision. […] Individuals with normal colonoscopy, or with <20 hyperplastic polyps <10 mm, should undergo surveillance in 10 years. [...] Individuals with 1–2 adenomas <10 mm should undergo surveillance colonoscopy in 7–10 years. In those with 3–4 adenomas <10 mm, surveillance should occur in 3–5 years.

• #29 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  Individuals with 5–10 adenomas, adenoma ≥10 mm, or adenoma with villous component or high-grade dysplasia should undergo surveillance in 3 years. […] Patients with >10 adenomas should return for surveillance in 1 year, with consideration for genetic testing based on adenoma burden, age, and family history. […] In case of piecemeal resection of adenoma ≥20 mm, surveillance colonoscopy should occur in 6 months, then 1 year later, then 3 years after the second examination. […] Individuals with 1–2 sessile serrated polyps (SSPs) <10 mm should undergo surveillance colonoscopy in 5–10 years. In those with 3–4 SSPs <10 mm or hyperplastic polyp ≥10 mm, surveillance should occur in 3–5 years. [...] Individuals with 5–10 SSPs, SSP ≥10 mm, SSP with dysplasia, or traditional serrated adenoma should undergo surveillance in 3 years.

• #30 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  Individuals with 5–10 adenomas, adenoma ≥10 mm, or adenoma with villous component or high-grade dysplasia should undergo surveillance in 3 years. […] Patients with >10 adenomas should return for surveillance in 1 year, with consideration for genetic testing based on adenoma burden, age, and family history. […] In case of piecemeal resection of adenoma ≥20 mm, surveillance colonoscopy should occur in 6 months, then 1 year later, then 3 years after the second examination. […] Individuals with 1–2 sessile serrated polyps (SSPs) <10 mm should undergo surveillance colonoscopy in 5–10 years. In those with 3–4 SSPs <10 mm or hyperplastic polyp ≥10 mm, surveillance should occur in 3–5 years. [...] Individuals with 5–10 SSPs, SSP ≥10 mm, SSP with dysplasia, or traditional serrated adenoma should undergo surveillance in 3 years.

• #31 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  Individuals with 5–10 adenomas, adenoma ≥10 mm, or adenoma with villous component or high-grade dysplasia should undergo surveillance in 3 years. […] Patients with >10 adenomas should return for surveillance in 1 year, with consideration for genetic testing based on adenoma burden, age, and family history. […] In case of piecemeal resection of adenoma ≥20 mm, surveillance colonoscopy should occur in 6 months, then 1 year later, then 3 years after the second examination. […] Individuals with 1–2 sessile serrated polyps (SSPs) <10 mm should undergo surveillance colonoscopy in 5–10 years. In those with 3–4 SSPs <10 mm or hyperplastic polyp ≥10 mm, surveillance should occur in 3–5 years. [...] Individuals with 5–10 SSPs, SSP ≥10 mm, SSP with dysplasia, or traditional serrated adenoma should undergo surveillance in 3 years.

• #32 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  Individuals with 5–10 adenomas, adenoma ≥10 mm, or adenoma with villous component or high-grade dysplasia should undergo surveillance in 3 years. […] Patients with >10 adenomas should return for surveillance in 1 year, with consideration for genetic testing based on adenoma burden, age, and family history. […] In case of piecemeal resection of adenoma ≥20 mm, surveillance colonoscopy should occur in 6 months, then 1 year later, then 3 years after the second examination. […] Individuals with 1–2 sessile serrated polyps (SSPs) <10 mm should undergo surveillance colonoscopy in 5–10 years. In those with 3–4 SSPs <10 mm or hyperplastic polyp ≥10 mm, surveillance should occur in 3–5 years. [...] Individuals with 5–10 SSPs, SSP ≥10 mm, SSP with dysplasia, or traditional serrated adenoma should undergo surveillance in 3 years.

• #33 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  Individuals with 5–10 adenomas, adenoma ≥10 mm, or adenoma with villous component or high-grade dysplasia should undergo surveillance in 3 years. […] Patients with >10 adenomas should return for surveillance in 1 year, with consideration for genetic testing based on adenoma burden, age, and family history. […] In case of piecemeal resection of adenoma ≥20 mm, surveillance colonoscopy should occur in 6 months, then 1 year later, then 3 years after the second examination. […] Individuals with 1–2 sessile serrated polyps (SSPs) <10 mm should undergo surveillance colonoscopy in 5–10 years. In those with 3–4 SSPs <10 mm or hyperplastic polyp ≥10 mm, surveillance should occur in 3–5 years. [...] Individuals with 5–10 SSPs, SSP ≥10 mm, SSP with dysplasia, or traditional serrated adenoma should undergo surveillance in 3 years.

• #34 Updated Polypectomy Surveillance Recommendationslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na50884/2020/02/12/updated-polypectomy-surveillance-recommendations

  Individuals with 5–10 adenomas, adenoma ≥10 mm, or adenoma with villous component or high-grade dysplasia should undergo surveillance in 3 years. […] Patients with >10 adenomas should return for surveillance in 1 year, with consideration for genetic testing based on adenoma burden, age, and family history. […] In case of piecemeal resection of adenoma ≥20 mm, surveillance colonoscopy should occur in 6 months, then 1 year later, then 3 years after the second examination. […] Individuals with 1–2 sessile serrated polyps (SSPs) <10 mm should undergo surveillance colonoscopy in 5–10 years. In those with 3–4 SSPs <10 mm or hyperplastic polyp ≥10 mm, surveillance should occur in 3–5 years. [...] Individuals with 5–10 SSPs, SSP ≥10 mm, SSP with dysplasia, or traditional serrated adenoma should undergo surveillance in 3 years.

• #35 Updated surveillance guidance for people who have had polyps or previous cancer removed | Bowel Cancer UK

  https://www.bowelcanceruk.org.uk/news-and-blogs/research-blog/updated-surveillance-guidance-for-people-who-have-had-polyps-or-previous-cancer-removed/

  For people who have had a bowel cancer removed, it is recommended that, after treatment, patients should have a follow-up colonoscopy after one year and another surveillance colonoscopy after a further three years. […] High risk of developing more polyps: Most people with 'high risk findings’ during a colonoscopy will be invited to have surveillance after three years. […] It usually takes at least 10 years for a polyp to develop into a high-risk polyp or cancer. Although colonoscopy is generally a safe procedure, the risks of a complication are greater in people over 75, so in general surveillance colonoscopy is not recommended for those over this age. […] This new guidance is more tailored to an individual’s level of risk, as it considers how old someone is, as well as the number and type of polyps that were found at their initial colonoscopy. […] These guidelines are being applied retrospectively, which means some low-risk people currently receiving surveillance colonoscopies will no longer need to.

• #36 Polyp & Colonoscopy Surveillance Guidelines: BSG/ACPGBI/PHE

  https://www.bsg.org.uk/clinical-resource/list-of-recommendations

  These guidelines have been reviewed and endorsed by BSG CSSC and ACPGBI, and have now been published in Gut: Rutter MD, East J, Rees CJ, et al. Gut 2020;69:201–223. […] They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 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. […] The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise EITHER: 2 or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10mm in size or containing any grade of dysplasia, or an adenoma of at least 10mm in size or containing high-grade dysplasia); OR 5 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.

• #37

  https://fascrs.org/patients/diseases-and-conditions/a-z/screening-and-surveillance-for-colorectal-cancer-e

  Surveillance refers to the process of evaluating patients with a personal history of polyps or cancer. People who have precancerous polyps completely removed should have a colonoscopy every 3-5 years, depending on the size and number of polyps found. […] If a polyp is not completely removed by colonoscopy or surgery, and the biopsy results are completely benign, another colonoscopy should be done in 3-6 months. Every effort should be made to remove polyps, as there is a significant risk that over time they can progress to an invasive cancer. […] Most patients who have a colorectal cancer removed surgically should have a colonoscopy within one year. If the whole colon could not be examined prior to surgery, then colonoscopy should be done within 3-6 months after surgery. If this first surveillance is normal, then follow-up colonoscopy should be done every 3-5 years. The risk of developing another colorectal cancer is estimated to be about 0.3% per year.

• #38 Colonic Polyps: Diagnosis and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6878826/

  High-risk individuals include patients with a significant family history of CRC or polyps, those with likely or confirmed hereditary CR cancer syndromes, and those with high-risk medical conditions. […] Patients with hereditary syndromes should initiate screening at a younger age and repeat CR screening at shorter intervals. […] Patients with inflammatory bowel disease (IBD, including ulcerative colitis [UC] or Crohn disease [CD]) have increased risk of CRC compared with the general population. […] In IBD patients, it is recommended for initial colonoscopy starting 8 years after onset of pan-colitis, or 12 to 15 years after onset of left-sided colitis, with ongoing surveillance every 1 to 2 years. […] Screening and surveillance methods for CRC vary widely in effectiveness for polyp and CRC detection, patient compliance, and invasiveness.

• #39

  https://bpac.org.nz/2021/bowel-polyps.aspx

  It is recognised that the risk of bowel cancer varies with the type and number of polyps found at colonoscopy. Not all bowel polyps have the potential to become malignant and not all patients who have been found to have polyps will go on to have recurrent polyps and therefore an increased risk of bowel cancer. The general aim is that surveillance should be performed at the minimum frequency required to reduce morbidity and mortality from bowel cancer. This should be balanced against the risks of harm from colonoscopy, such as any psychological distress or complications of the procedure, and also against the financial impact to the health system (and potentially to individuals). […] Inflammatory bowel disease (IBD) is associated with an increased risk of development of bowel cancer. The risk can be classified as low, intermediate or high, largely reflecting the extensiveness and level of activity of the two main forms of IBD, either ulcerative colitis or Crohns disease. Recommendations from 2012, state that: A baseline colonoscopy and biopsies as appropriate should be performed 8 10 years after a definitive diagnosis of IBD. Ongoing surveillance with colonoscopy should be offered depending on the patients level of risk: Low risk: colonoscopy at five years, Intermediate risk: colonoscopy at three years, High risk: colonoscopy at one year. […] N.B. For those at intermediate or high risk, the intervals can be extended to five years provided there have been two consecutive colonoscopies that show quiescent disease with no dysplasia, and no other risk factors (i.e. family history, a stricture or primary sclerosing cholangitis).

• #40 Colonic Polyps: Diagnosis and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6878826/

  High-risk individuals include patients with a significant family history of CRC or polyps, those with likely or confirmed hereditary CR cancer syndromes, and those with high-risk medical conditions. […] Patients with hereditary syndromes should initiate screening at a younger age and repeat CR screening at shorter intervals. […] Patients with inflammatory bowel disease (IBD, including ulcerative colitis [UC] or Crohn disease [CD]) have increased risk of CRC compared with the general population. […] In IBD patients, it is recommended for initial colonoscopy starting 8 years after onset of pan-colitis, or 12 to 15 years after onset of left-sided colitis, with ongoing surveillance every 1 to 2 years. […] Screening and surveillance methods for CRC vary widely in effectiveness for polyp and CRC detection, patient compliance, and invasiveness.

• #41

  https://fascrs.org/patients/diseases-and-conditions/a-z/screening-and-surveillance-for-colorectal-cancer-e

  Patients with ulcerative or Crohns colitis for eight or more years should have a colonoscopy with multiple biopsies every 1-2 years. Pre-cancerous changes may be hard to evaluate in the presence of long-standing inflammation. Once these pre-cancerous changes (called dysplasia) are found, complete removal of the colon and rectum is usually recommended; the rate of finding an invasive cancer in these patients is 6-10%.

• #42

  https://bpac.org.nz/2021/bowel-polyps.aspx

  It is recognised that the risk of bowel cancer varies with the type and number of polyps found at colonoscopy. Not all bowel polyps have the potential to become malignant and not all patients who have been found to have polyps will go on to have recurrent polyps and therefore an increased risk of bowel cancer. The general aim is that surveillance should be performed at the minimum frequency required to reduce morbidity and mortality from bowel cancer. This should be balanced against the risks of harm from colonoscopy, such as any psychological distress or complications of the procedure, and also against the financial impact to the health system (and potentially to individuals). […] Inflammatory bowel disease (IBD) is associated with an increased risk of development of bowel cancer. The risk can be classified as low, intermediate or high, largely reflecting the extensiveness and level of activity of the two main forms of IBD, either ulcerative colitis or Crohns disease. Recommendations from 2012, state that: A baseline colonoscopy and biopsies as appropriate should be performed 8 10 years after a definitive diagnosis of IBD. Ongoing surveillance with colonoscopy should be offered depending on the patients level of risk: Low risk: colonoscopy at five years, Intermediate risk: colonoscopy at three years, High risk: colonoscopy at one year. […] N.B. For those at intermediate or high risk, the intervals can be extended to five years provided there have been two consecutive colonoscopies that show quiescent disease with no dysplasia, and no other risk factors (i.e. family history, a stricture or primary sclerosing cholangitis).

• #43

  https://bpac.org.nz/2021/bowel-polyps.aspx

  It is recognised that the risk of bowel cancer varies with the type and number of polyps found at colonoscopy. Not all bowel polyps have the potential to become malignant and not all patients who have been found to have polyps will go on to have recurrent polyps and therefore an increased risk of bowel cancer. The general aim is that surveillance should be performed at the minimum frequency required to reduce morbidity and mortality from bowel cancer. This should be balanced against the risks of harm from colonoscopy, such as any psychological distress or complications of the procedure, and also against the financial impact to the health system (and potentially to individuals). […] Inflammatory bowel disease (IBD) is associated with an increased risk of development of bowel cancer. The risk can be classified as low, intermediate or high, largely reflecting the extensiveness and level of activity of the two main forms of IBD, either ulcerative colitis or Crohns disease. Recommendations from 2012, state that: A baseline colonoscopy and biopsies as appropriate should be performed 8 10 years after a definitive diagnosis of IBD. Ongoing surveillance with colonoscopy should be offered depending on the patients level of risk: Low risk: colonoscopy at five years, Intermediate risk: colonoscopy at three years, High risk: colonoscopy at one year. […] N.B. For those at intermediate or high risk, the intervals can be extended to five years provided there have been two consecutive colonoscopies that show quiescent disease with no dysplasia, and no other risk factors (i.e. family history, a stricture or primary sclerosing cholangitis).

• #44 Surveillance of colonic polyps: Are we getting it right?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4726668/

  Individuals found to have colonic polyps are at increased risk of advanced neoplasia in the future. This risk may be due to a number of mechanisms: (1) Missed lesions at the initial colonoscopy; (2) Incomplete removal of adenomatous tissue at initial colonoscopy; and (3) The individuals propensity to colonic neoplasia (either lifestyle factors, an inherent imbalance of cell proliferation, or a combination of these). […] Although the risk of developing further adenomas is known, no randomised study has directly assessed the effect of post-polypectomy surveillance on CRC incidence or mortality. The efficacy of surveillance has been assessed by retrospective epidemiological series indicating that patients not entered into a surveillance programme have three- to fourfold greater risk of CRC. However, the increased risk pertains to those found to have advanced adenomas at the index procedure. Individuals with non-advanced adenomas did not have significantly higher risk than the general population.

• #45 Surveillance of colonic polyps: Are we getting it right?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4726668/

  Individuals found to have colonic polyps are at increased risk of advanced neoplasia in the future. This risk may be due to a number of mechanisms: (1) Missed lesions at the initial colonoscopy; (2) Incomplete removal of adenomatous tissue at initial colonoscopy; and (3) The individuals propensity to colonic neoplasia (either lifestyle factors, an inherent imbalance of cell proliferation, or a combination of these). […] Although the risk of developing further adenomas is known, no randomised study has directly assessed the effect of post-polypectomy surveillance on CRC incidence or mortality. The efficacy of surveillance has been assessed by retrospective epidemiological series indicating that patients not entered into a surveillance programme have three- to fourfold greater risk of CRC. However, the increased risk pertains to those found to have advanced adenomas at the index procedure. Individuals with non-advanced adenomas did not have significantly higher risk than the general population.

• #46 Surveillance of colonic polyps: Are we getting it right?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4726668/

  It is established that individuals with previously identified adenomas have an increased risk of further adenomas at a follow-up examination. At 4 year interval, 35.5% of patients will again be found to have at least one adenoma, but only 8.6%-12% will have advanced neoplasia (either an advanced adenoma or carcinoma) with 0.6% having carcinoma. Factors conferring higher risk of further adenomas at surveillance are age greater than 60 years, male sex, and the presence of more than one adenoma at the initial procedure. The finding of more than 2 adenomas at initial examination increases the risk of advanced neoplasia at follow-up examination. […] The evidence to support the use of surveillance applies predominantly to the high risk group. The incidence of advanced neoplasia and carcinoma in these individuals is significantly increased at follow-up, and CRC mortality is reduced by their surveillance.

• #47 Surveillance of colonic polyps: Are we getting it right?

  https://www.wjgnet.com/1007-9327/full/v22/i6/1925.htm

  Individuals found to have colonic polyps are at increased risk of advanced neoplasia in the future. This risk may be due to a number of mechanisms: (1) Missed lesions at the initial colonoscopy; (2) Incomplete removal of adenomatous tissue at initial colonoscopy; and (3) The individuals propensity to colonic neoplasia (either lifestyle factors, an inherent imbalance of cell proliferation, or a combination of these). […] It is established that individuals with previously identified adenomas have an increased risk of further adenomas at a follow-up examination. At 4 year interval, 35.5% of patients will again be found to have at least one adenoma, but only 8.6%-12% will have advanced neoplasia (either an advanced adenoma or carcinoma) with 0.6% having carcinoma. Factors conferring higher risk of further adenomas at surveillance are age greater than 60 years, male sex, and the presence of more than one adenoma at the initial procedure. The finding of more than 2 adenomas at initial examination increases the risk of advanced neoplasia at follow-up examination. […] The evidence to support the use of surveillance applies predominantly to the high risk group. The incidence of advanced neoplasia and carcinoma in these individuals is significantly increased at follow-up, and CRC mortality is reduced by their surveillance.

• #48 Surveillance of colonic polyps: Are we getting it right?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4726668/

  It is established that individuals with previously identified adenomas have an increased risk of further adenomas at a follow-up examination. At 4 year interval, 35.5% of patients will again be found to have at least one adenoma, but only 8.6%-12% will have advanced neoplasia (either an advanced adenoma or carcinoma) with 0.6% having carcinoma. Factors conferring higher risk of further adenomas at surveillance are age greater than 60 years, male sex, and the presence of more than one adenoma at the initial procedure. The finding of more than 2 adenomas at initial examination increases the risk of advanced neoplasia at follow-up examination. […] The evidence to support the use of surveillance applies predominantly to the high risk group. The incidence of advanced neoplasia and carcinoma in these individuals is significantly increased at follow-up, and CRC mortality is reduced by their surveillance.

• #49 Surveillance of colonic polyps: Are we getting it right?

  https://www.wjgnet.com/1007-9327/full/v22/i6/1925.htm

  Individuals found to have colonic polyps are at increased risk of advanced neoplasia in the future. This risk may be due to a number of mechanisms: (1) Missed lesions at the initial colonoscopy; (2) Incomplete removal of adenomatous tissue at initial colonoscopy; and (3) The individuals propensity to colonic neoplasia (either lifestyle factors, an inherent imbalance of cell proliferation, or a combination of these). […] It is established that individuals with previously identified adenomas have an increased risk of further adenomas at a follow-up examination. At 4 year interval, 35.5% of patients will again be found to have at least one adenoma, but only 8.6%-12% will have advanced neoplasia (either an advanced adenoma or carcinoma) with 0.6% having carcinoma. Factors conferring higher risk of further adenomas at surveillance are age greater than 60 years, male sex, and the presence of more than one adenoma at the initial procedure. The finding of more than 2 adenomas at initial examination increases the risk of advanced neoplasia at follow-up examination. […] The evidence to support the use of surveillance applies predominantly to the high risk group. The incidence of advanced neoplasia and carcinoma in these individuals is significantly increased at follow-up, and CRC mortality is reduced by their surveillance.

• #50 Surveillance of colonic polyps: Are we getting it right?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4726668/

  It is established that individuals with previously identified adenomas have an increased risk of further adenomas at a follow-up examination. At 4 year interval, 35.5% of patients will again be found to have at least one adenoma, but only 8.6%-12% will have advanced neoplasia (either an advanced adenoma or carcinoma) with 0.6% having carcinoma. Factors conferring higher risk of further adenomas at surveillance are age greater than 60 years, male sex, and the presence of more than one adenoma at the initial procedure. The finding of more than 2 adenomas at initial examination increases the risk of advanced neoplasia at follow-up examination. […] The evidence to support the use of surveillance applies predominantly to the high risk group. The incidence of advanced neoplasia and carcinoma in these individuals is significantly increased at follow-up, and CRC mortality is reduced by their surveillance.

• #51 Surveillance of colonic polyps: Are we getting it right?

  https://www.wjgnet.com/1007-9327/full/v22/i6/1925.htm

  Individuals found to have colonic polyps are at increased risk of advanced neoplasia in the future. This risk may be due to a number of mechanisms: (1) Missed lesions at the initial colonoscopy; (2) Incomplete removal of adenomatous tissue at initial colonoscopy; and (3) The individuals propensity to colonic neoplasia (either lifestyle factors, an inherent imbalance of cell proliferation, or a combination of these). […] It is established that individuals with previously identified adenomas have an increased risk of further adenomas at a follow-up examination. At 4 year interval, 35.5% of patients will again be found to have at least one adenoma, but only 8.6%-12% will have advanced neoplasia (either an advanced adenoma or carcinoma) with 0.6% having carcinoma. Factors conferring higher risk of further adenomas at surveillance are age greater than 60 years, male sex, and the presence of more than one adenoma at the initial procedure. The finding of more than 2 adenomas at initial examination increases the risk of advanced neoplasia at follow-up examination. […] The evidence to support the use of surveillance applies predominantly to the high risk group. The incidence of advanced neoplasia and carcinoma in these individuals is significantly increased at follow-up, and CRC mortality is reduced by their surveillance.

• #52 Association between the location of colon polyps at baseline and surveillance colonoscopy: a retrospective study

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000900006

  Association between the location of colon polyps at baseline and surveillance colonoscopy – A retrospective study […] Several factors are used to stratify the probability of polyp recurrence. However, there are no studies correlating the location of the initial polyps and the recurrent ones. The aim of this study was to verify whether the polyp location at the surveillance colonoscopy was correlated with the location of the previously excised polyps at the baseline colonoscopy. […] Out of the 346 patients who underwent repeated colonoscopy, 268 (77.4%) had at least 1 polyp detected. For all the segments there was an increased risk of recurrent polyps in the same location and it was about four times higher in proximal (OR 3.5; CI 2.1-6.0) and distal colon segments (OR 3.8; CI 2.1-6.8), followed by three times higher in the rectum (OR 2.6; CI 1.5-4.6).

• #53 Association between the location of colon polyps at baseline and surveillance colonoscopy: a retrospective study

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000900006

  There seems to be a significant association between polyp location at baseline and surveillance colonoscopy. […] Adenomas of the colon and rectum are common benign neoplastic lesions discovered in about 25% of patients submitted to colonoscopy. Colorectal cancer (CRC) is the third most frequent cancer and the fourth cause of death due to cancer worldwide. Colonoscopy and endoscopic detection and resection of precancerous lesions lead to a reduction in the incidence and mortality caused by CRC. […] Surveillance colonoscopy is recommended in patients with previous adenomatous polyps, because of the risk of metachronous, recurrent and new lesions. The risk of finding adenomas on surveillance colonoscopy is dependent on the findings of the initial colonoscopy. […] In our study we found a significant association between the initial polyp location and the recurrent one. For all the colon segments, the presence of polyps at baseline colonoscopy confers a significant risk for recurrence in the same location at surveillance colonoscopy. This risk is about four times higher in the distal colon, closely followed by the proximal colon.

• #54 Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl20166

  Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey […] Background/Aims: As the number of colonoscopies and polypectomies performed continues to increase in many Asian countries, there is a great demand for surveillance colonoscopy. The aim of this study was to investigate the adherence to postpolypectomy surveillance guidelines among physicians in Asia. […] Methods: A survey study was performed in seven Asian countries. An email invitation with a link to the survey was sent to participants who were asked to complete the questionnaire consisting of eight clinical scenarios. […] Results: Of the 137 doctors invited, 123 (89.8%) provided valid responses. Approximately 50% of the participants adhered to the guidelines regardless of the risk of adenoma, except in the case of tubulovillous adenoma 10 mm combined with high-grade dysplasia, in which 35% of the participants adhered to the guidelines. The participants were stratified according to the number of colonoscopies performed: 20 colonoscopies per month (high volume group) and 20 colonoscopies per month (low volume group). Higher adherence to the postpolypectomy surveillance guidelines was evident in the high volume group (60%) than in the low volume group (25%). The reasons for nonadherence included concern of missed polyps (59%), the low cost of colonoscopy (26%), concern of incomplete resection (25%), and concern of medical liability (15%).

• #55 Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl20166

  Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey […] Background/Aims: As the number of colonoscopies and polypectomies performed continues to increase in many Asian countries, there is a great demand for surveillance colonoscopy. The aim of this study was to investigate the adherence to postpolypectomy surveillance guidelines among physicians in Asia. […] Methods: A survey study was performed in seven Asian countries. An email invitation with a link to the survey was sent to participants who were asked to complete the questionnaire consisting of eight clinical scenarios. […] Results: Of the 137 doctors invited, 123 (89.8%) provided valid responses. Approximately 50% of the participants adhered to the guidelines regardless of the risk of adenoma, except in the case of tubulovillous adenoma 10 mm combined with high-grade dysplasia, in which 35% of the participants adhered to the guidelines. The participants were stratified according to the number of colonoscopies performed: 20 colonoscopies per month (high volume group) and 20 colonoscopies per month (low volume group). Higher adherence to the postpolypectomy surveillance guidelines was evident in the high volume group (60%) than in the low volume group (25%). The reasons for nonadherence included concern of missed polyps (59%), the low cost of colonoscopy (26%), concern of incomplete resection (25%), and concern of medical liability (15%).

• #56 Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl20166

  Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey […] Background/Aims: As the number of colonoscopies and polypectomies performed continues to increase in many Asian countries, there is a great demand for surveillance colonoscopy. The aim of this study was to investigate the adherence to postpolypectomy surveillance guidelines among physicians in Asia. […] Methods: A survey study was performed in seven Asian countries. An email invitation with a link to the survey was sent to participants who were asked to complete the questionnaire consisting of eight clinical scenarios. […] Results: Of the 137 doctors invited, 123 (89.8%) provided valid responses. Approximately 50% of the participants adhered to the guidelines regardless of the risk of adenoma, except in the case of tubulovillous adenoma 10 mm combined with high-grade dysplasia, in which 35% of the participants adhered to the guidelines. The participants were stratified according to the number of colonoscopies performed: 20 colonoscopies per month (high volume group) and 20 colonoscopies per month (low volume group). Higher adherence to the postpolypectomy surveillance guidelines was evident in the high volume group (60%) than in the low volume group (25%). The reasons for nonadherence included concern of missed polyps (59%), the low cost of colonoscopy (26%), concern of incomplete resection (25%), and concern of medical liability (15%).

• #57 Surveillance of colonic polyps: Are we getting it right?

  https://www.wjgnet.com/1007-9327/abstract/v22/i6/1925.htm

  Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. The identification of colonic polyps can reduce CRC mortality through earlier diagnosis of cancers and the removal of polyps: the precursor lesion of CRC. Following the finding and removal of colonic polyps at an initial colonoscopy, some patients are at an increased risk of developing CRC in the future. This is the rationale for post-polypectomy surveillance colonoscopy. […] The potential benefits of surveillance procedures must be weighed against the burden of colonoscopy: resource use, the potential for patient discomfort, and the risk of complications. Therefore surveillance colonoscopy is best utilised in a selected group of individuals at a high risk of developing cancer. Further study is needed into the specific factors conferring higher risk as well as the efficacy of surveillance in mitigating this risk. Such evidence will better inform clinicians and patients of the relative benefits of colonoscopic surveillance for the individual. In addition, the decision to continue with surveillance must be informed by the changing profile of risks and benefits of further procedures with the patients advancing age.

• #58 Surveillance guidelines after removal of colorectal adenomatous polyps | Gut

  https://gut.bmj.com/content/51/suppl_5/v6

  It has been shown consistently that patients with three or more adenomas are a high risk group for the development of advanced adenomas and cancer, particularly if one of the adenomas is also large (1 cm). […] Although not entirely consistent, the data suggest that an additional colonoscopy at 12 months is warranted in people found at a single colonoscopy to have five or more, small adenomas or three or more adenomas, at least one of which is large. […] The cut off age for stopping surveillance is usually quoted as 75 years as the remaining life expectancy is likely to be less than the average time required for new adenomas to become malignant. […] The risks and benefits of adenoma surveillance need to be balanced at all ages, particularly in patients who have significant comorbidity.

• #59 When to Discontinue Colon Polyp Surveillance in Older Adults? – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/yen_june2024/

  Overall, the rate of CRC on surveillance colonoscopy in individuals ≥70 years old with non-advanced adenomas on prior colonoscopy was 0.2% with 10.4% having advanced adenomas. Considering that it takes multiple years for an advanced adenoma to develop into CRC, the yield of surveillance colonoscopy to prevent CRC in patients with history of non-advanced adenomas seems low. […] In older patients ≥ 70 years old with prior non-advanced adenomas, I tend to encourage cessation or limitation of future colonoscopies. This does not preclude future onset of CRC, but it is important to discuss with the patient that performing colonoscopy at an elderly age may not be worth the burden of bowel preparation or procedural risk compared to a low future CRC risk. […] While this study can aid us in shared decision-making regarding cessation of colonoscopy in older patients with prior adenomas overall, future studies that attempt to differentiate risk based on type of previous advanced polyps (i.e., based on size alone, or advanced histology such as high grade dysplasia) would assist in targeting those who may be at particularly higher risk of future CRC. Future research regarding cessation of colonoscopy in those with prior CRC may also similarly assist in determining cessation of surveillance colonoscopies.

• #60 When to Discontinue Colon Polyp Surveillance in Older Adults? – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/yen_june2024/

  Overall, the rate of CRC on surveillance colonoscopy in individuals ≥70 years old with non-advanced adenomas on prior colonoscopy was 0.2% with 10.4% having advanced adenomas. Considering that it takes multiple years for an advanced adenoma to develop into CRC, the yield of surveillance colonoscopy to prevent CRC in patients with history of non-advanced adenomas seems low. […] In older patients ≥ 70 years old with prior non-advanced adenomas, I tend to encourage cessation or limitation of future colonoscopies. This does not preclude future onset of CRC, but it is important to discuss with the patient that performing colonoscopy at an elderly age may not be worth the burden of bowel preparation or procedural risk compared to a low future CRC risk. […] While this study can aid us in shared decision-making regarding cessation of colonoscopy in older patients with prior adenomas overall, future studies that attempt to differentiate risk based on type of previous advanced polyps (i.e., based on size alone, or advanced histology such as high grade dysplasia) would assist in targeting those who may be at particularly higher risk of future CRC. Future research regarding cessation of colonoscopy in those with prior CRC may also similarly assist in determining cessation of surveillance colonoscopies.

• #61 Surveillance guidelines after removal of colorectal adenomatous polyps | Gut

  https://gut.bmj.com/content/51/suppl_5/v6

  Most colon cancers are assumed to have a premalignant adenomatous polyp phase, therefore colonoscopic detection and polypectomy provides the opportunity for cancer prevention. […] Some patients who have undergone colonoscopy and have had adenomas removed are at increased risk of developing colorectal cancer (CRC) in the future, and therefore might benefit from colonoscopic surveillance. […] It is also an under-resourced procedure in the UK, with a serious lack of fully trained endoscopists. […] Around one third of the population will develop an adenoma by age 60. […] Most adenomas are asymptomatic and remain undiagnosed. […] There are few data on the benefits of colonoscopic surveillance in preventing colorectal cancer after a baseline clearing colonoscopy. […] It is therefore important that this practice is applied judiciously, balancing the risks and benefits in each individual case.

• #62 Surveillance guidelines after removal of colorectal adenomatous polyps | Gut

  https://gut.bmj.com/content/51/suppl_5/v6

  Using published evidence, this guideline recommends appropriate surveillance after adenoma removal. […] The decision to perform each follow up colonoscopy should also depend on the patients wishes, the presence of comorbidity, the patients age, and the presence of other risk factors. […] The concept that most cancers arise from pre-existing adenomas is now widely accepted, based on epidemiological, clinical, postmortem, and molecular biological studies. […] Synchronous adenomas and cancers are a common finding as are adenomas with a focus of malignancy. […] Adenomas are diagnosed on average 10 years earlier than CRCs, providing temporal evidence for the adenoma-carcinoma sequence. […] Genetic changes have been identified that seem to promote the growth of adenomas and their malignant transformation.

• #63 Surveillance of colonic polyps: Are we getting it right?

  https://www.wjgnet.com/1007-9327/abstract/v22/i6/1925.htm

  Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. The identification of colonic polyps can reduce CRC mortality through earlier diagnosis of cancers and the removal of polyps: the precursor lesion of CRC. Following the finding and removal of colonic polyps at an initial colonoscopy, some patients are at an increased risk of developing CRC in the future. This is the rationale for post-polypectomy surveillance colonoscopy. […] The potential benefits of surveillance procedures must be weighed against the burden of colonoscopy: resource use, the potential for patient discomfort, and the risk of complications. Therefore surveillance colonoscopy is best utilised in a selected group of individuals at a high risk of developing cancer. Further study is needed into the specific factors conferring higher risk as well as the efficacy of surveillance in mitigating this risk. Such evidence will better inform clinicians and patients of the relative benefits of colonoscopic surveillance for the individual. In addition, the decision to continue with surveillance must be informed by the changing profile of risks and benefits of further procedures with the patients advancing age.

• #64 Colonoscopy surveillance after colon (colonic) polyp (polyps) – Primary Care Notebook

  https://primarycarenotebook.com/pages/gastroenterology/colonoscopy-surveillance-after-colon-colonic-polyp-polyps

  Consensus guidelines have been developed by the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland and Public Health England. Key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise EITHER: 2 or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10mm in size or containing any grade of dysplasia, or an adenoma of at least 10mm in size or containing high-grade dysplasia); OR 5 or more premalignant polyps. […] A study found that stool-based post-polypectomy surveillance strategies (microsimulation modelling using annual FIT-based surveillance with FOB-gold at a threshold 32 g/g faeces) can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.

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