Evidence-based clinical practice guidelines for management of colorectal polyps

Abstract

Background Recently in Japan, the morbidity of colorectal polyp has been increasing. As a result, a large number of cases of colorectal polyps that are diagnosed and treated using colonoscopy has now increased, and clinical guidelines are needed for endoscopic management and surveillance after treatment. Methods Three committees [the professional committee for making clinical questions (CQs) and statements by Japanese specialists, the expert panelist committee for rating statements by the modified Delphi method, and the evaluating committee by moderators] were organized. Ten specialists for colorectal polyp management extracted the specific clinical statements from articles published between 1983 and September 2011 obtained from PubMed and a secondary database, and developed the CQs and statements. Basically, statements were made according to the GRADE system. The expert panel individually rated the clinical statements using a modified Delphi approach, in which a clinical statement receiving a median score greater than seven on a nine-point scale from the panel was regarded as valid. Results The professional committee created 91CQs and statements for the current concept and diagnosis/treatment of various colorectal polyps including epidemiology, screening, pathophysiology, definition and classification, diagnosis, treatment/management, practical treatment, complications and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumor/carcinoma). Conclusions After evaluation by the moderators, evidence-based clinical guidelines for management of colorectal polyps have been proposed for 2014.

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

“…There is no mention in the Japanese Colorectal Polyp guidelines [21] about CP, but it is stated in the guidelines that conventional polypectomy for polyps <5 mm in size involves more risk than benefit. We think this trend should be changed in the future.…”

Polyp detection rate in transverse and sigmoid colon significantly increases with longer withdrawal time during screening colonoscopy

“…A prospective large study involving 2053 subjects of first screening colonoscopies showed a strong direct correlation between WT and all adenoma detection rate (r = 0.90) [8] and a study using multivariate analysis indicated that the endoscopist was more powerful on adenoma detection than the well-established predictions of advancing age or male gender [10]. The Japanese guidelines recommend that diminutive adenomas ≤ 5 mm should be followed up in the absence of colonoscopic findings suggestive of carcinoma [11]. Most of diminutive polyps including adenoma are characterized at real-time using narrow-band imaging, and are not necessarily removed nor diagnosed by pathological examination in the clinical practice [12].…”

Surveillance after colorectal polyp removal

“…Experimental research, as a next step, is necessary to establish optimal surveillance strategies and time-intervals. On the other hand, it is [55] 1e2 adenomas <10 mm Intermediate 3e4 adenomas Any 10 mm High 5 adenomas 3 adenomas with at least one 10 mm Japan Society of Gastroenterology [72] 5 mm 5 mm Cancer Council Australia [73] 1e2 adenomas <10 mm 3 adenomas Any 10 mm HGD Villous component a It is optional to consider these risk factors or not. possible that in future, other factors like molecular markers detected in polyps, blood or stool might provide information about an individual's risk to develop metachronous advanced neoplasia, going beyond size and number of polyps as main indicators for surveillance colonoscopies.…”