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BSG/ACPGBI/PHE Post-polypectomy and post-colorectal cancer resection surveillance guidelines 2019
Post-polypectomy
High-risk criteria for future colorectal cancer 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. If no high-risk findings, advise to participate in the national bowel screening programme when invited.
Patients with premalignant polyps but no high-risk findings, who are more than 10 years younger than the national bowel screening programme lower age-limit, should be considered for surveillance colonoscopy after 5 or 10 years.
Where histological completeness of excision cannot be determined in patients with: a non-pedunculated polyps of 10-19mm in size, or an adenoma containing high-grade dysplasia, or a serrated polyp containing any dysplasia, then a site-check should be considered within 2-6 months.
Pathologically en bloc R0 endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of large non-pedunculated colorectal polyps (of at least 20mm in size, LNPCP) or early polyp cancers do not require site-checks, but a post-polypectomy surveillance after an interval of 3 years.
Piecemeal EMR or ESD of LNPCPs need site check after 2-6 months. A further site-check at 18 months from the original resection is recommended to detect late recurrence. Once no recurrence is confirmed patients should undergo post-polypectomy surveillance after an interval of 3 years.
For post-polypectomy surveillance, CTC is an acceptable alternative if colonoscopy is incomplete or not possible.
Post-colorectal cancer resection
Post-colorectal cancer resection patients should undergo a 1-year clearance colonoscopy, then a surveillance colonoscopy after 3 more years. Need for further surveillance should then be determined in accordance with the post-polypectomy high-risk criteria.
Note: Surveillance should only be performed in people whose life-expectancy is greater than 10 years, and in general not in people older than about 75 years.
Reference
British Society of Gastroenterology. BSG/ACPGBI/PHE Post-polypectomy and post-colorectal cancer resection surveillance guidelines 2019. Retrieved from: www.bsg.org.uk/resource/bsg-acpgbi-phe-post-polypectomy-and-post-colorectal-cancer-resection-surveillance-guidelines.html
Author:
Ms Yanyu Tan
| Speciality:
General Surgery
| Date Added:
12/11/2019
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