Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Abstract

C olonoscopy is performed routinely for colorectal cancer (CRC) screening, follow-up of other abnormal screening tests, workup of signs and symptoms of gastrointestinal disease, and surveillance after CRC and polyp removal. Post procedure, colonoscopists are expected to provide followup recommendations to patients and referring physicians. Recommendations for follow-up after normal colonoscopy among individuals age-eligible for screening, and postpolypectomy among all individuals with polyps are among the most common clinical scenarios requiring guidance. 1 Risk of metachronous advanced neoplasia is associated with findings on prior colonoscopy. After high-quality colonoscopy, patients with no neoplasia detected are at the lowest risk, and those with polyps are risk-stratified based on the histology, number, location, and size of polyps detected. Since the release of the last US Multi-Society Task Force (Task Force) recommendations for post-colonoscopy follow-up and polyp surveillance in 2012, 2 a number of articles have been published on risk of CRC based on colonoscopy findings and patient characteristics, as well as the potential impact of screening and surveillance colonoscopy on outcomes, such as incident CRC and polyps. Further, recent studies increasingly reflect the modern era of colonoscopy with more awareness of the importance of quality factors (eg, adequate bowel preparation, cecal intubation, adequate adenoma detection, and complete polyp resection), and utilization of state of the art technologies (eg, high-definition colonoscopes). Higher-quality colonoscopy could impact the importance of previously identified risk factors. Our aim was to review newly available evidence and update recommendations for follow-up after colonoscopy with or without polypectomy. Methods Evidence Review and Recommendation DevelopmentTo identify issues of greatest importance for the current revision, we developed PICO (patient, intervention, comparison, and outcome) questions (Supplementary Appendix A [SG and DL, with input from TK]). In consultation with a certified medical librarian (KH), literature searches were performed in PubMed, Embase, and CINAHL with a combination of controlled vocabulary and keyword terms for colonoscopy, polyps, and polypectomy surveillance (see Supplementary Appendix B for search terms). English-language articles since January 1, 2012 were retrieved. Searches were run on March 30, 2017, and identified a total of 1904 unique articles (see Supplementary Appendix C for article selection flow).Criteria used for inclusion/exclusion of titles, abstracts, and articles are outlined in Table 1. All titles were reviewed by a single author (SG) and potentially relevant titles were selected for abstract review. All abstracts were reviewed by 2 authors (SG and DL) and potentially relevant abstracts were selected for full article review. Included articles were reviewed in detail by the same 2 authors. The final list of articles selected for review was supplemented by repeating the literature search through S...

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