Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Editorial: Colorectal Cancer Screening Education in Medically Vulnerable Populations: the Role of the Journal of Cancer Education

“…These guidelines are based on the number and pathology of the lesions found [10]. In order of increasing aggressiveness, adenomatous polyps can be classified as tubular, villous, and serrated.…”

“…Because of the high risk of cancer for serrated polyps, the USMTF recommends an interval colonoscopy at 5 years if the lesion is less than 1 cm and not dysplastic, 3 years if it is larger than 1 cm or dysplastic, 1 year if multiple lesions are found, and in 3-6 months if the lesion was not completely resected [10].…”

Adherence to Post-polypectomy Guidelines: Just One Piece of an Important Puzzle

“…The results from the hypothetical clinical scenarios used in the survey are interesting: In a scenario addressing piecemeal resection of advanced adenomas, 39 % of respondents chose longer-than-recommended surveillance intervals, of concern since it is estimated that 19-27 % of interval cancers arise in the same region of the colon where prior polyps were removed [7]. Residual polyp tissue from prior incomplete resection might be the source of interval cancer in these cases rather than a missed or de novo lesion.…”

“…In an attempt to understand the motivation underlying the scenario responses, Patel et al [6] reported that 82 % of respondents cited fear of missed cancer and 36 % cited malpractice concerns. Missing cancers is perhaps the greatest fear of gastroenterologists involved in screening and surveillance colonoscopy due to the perception that CRC is a largely preventable disease, yet there is a well-documented, finite, baseline polyp miss rate [7]. Placing more emphasis on high-quality colonoscopic examinations may help bolster individual physician and group confidence in the sensitivity of the procedure for detecting neoplasia, thereby by shifting behavior to more guideline-appropriate surveillance intervals.…”

Going Against Medical Advice: PCPs’ Role in Reducing Colonoscopy Overuse

“…Though the American Gastroenterological Association recommendation received a rating of moderate quality, some specialists may view the recommended intervals as too long. 7 In this setting, going against the specialist's recommendation could place the patient at increased risk.…”