Recommendations
Sr.no. |
Recommendations |
|
---|---|---|
1 |
No adenoma or polyps: There is now stronger evidence to support the 10-year interval after negative findings on baseline colonoscopy for average-risk individuals, assuming that the baseline colon examination is complete with a good bowel preparation. |
|
Evidence for Recommendation 1 | ||
2 |
No adenomas; distal small (<10 mm) hyperplastic polyps: Prior and current evidence suggests that distal HPs <10 mm are benign and nonneoplastic. If the most advanced lesions at baseline colonoscopy are distal HPs <10 mm, the interval for colonoscopic follow-up should be 10 years. |
Mod |
Evidence for Recommendation 2 | ||
3 |
1—2 tubular adenomas <10 mm: Data published since 2006 endorse the assessment that patients with 1—2 tubular adenomas with low-grade dysplasia <10 mm represent a low-risk group. Three new studies suggest that this group may have only a small, nonsignificant increase in risk of advanced neoplasia within 5 years compared with individuals with no baseline neoplasia. |
Mod |
Evidence for Recommendation 3 | ||
4 |
3—10 adenomas: The new information from the VA study and the NCI Pooling Project support the previous recommendation that patients with 3 or more adenomas have a level of risk for advanced neoplasia similar to other patients with advanced neoplasia (adenoma >10 mm, adenoma with HGD There are insufficient new data to support a change in the prior recommendation. |
Mod (if polyp ≥6 mm) |
Evidence for Recommendation 4 | ||
5 |
>10 adenomas: There is no basis for changing the recommendation to consider follow-up in less than 3 years after a baseline colonoscopy. |
|
Evidence for Recommendation 5 | ||
6 |
One or more tubular adenomas ≥10 mm: The new information provides additional data showing that patients with one or more adenomas ≥10 mm have an increased risk of advanced neoplasia during surveillance compared with those with no neoplasia or small (<10 mm) adenomas. There is no basis for changing the recommended 3-year surveillance interval. This recommendation assumes that the examination was of high quality and complete removal of neoplastic tissue occurred at baseline. This group represents a small proportion of all patients with adenomas. If there is question about complete removal (ie, piecemeal resection), early follow-up colonoscopy is warranted. |
|
Evidence for Recommendation 6 | ||
7 |
One or more adenomas with villous features of any size: The new information provides additional data showing that patients with one or more adenomas with villous histology have an increased risk of advanced neoplasia during surveillance compared with those with no neoplasia or small (<10 mm) tubular adenomas. There is no basis for changing the recommended 3-year surveillance interval. |
Mod |
Evidence for Recommendation 7 | ||
8 |
One or more adenomas with HGD: The presence of an adenoma with HGD is an important risk factor for development of advanced neoplasia and CRC during surveillance. There is no basis for changing the recommended 3-year surveillance interval. |
Mod |
Evidence for Recommendation 8 | ||
9 |
Serrated polyps: Prior surveillance guidelines did not comment on surveillance intervals if proximal serrated polyps are found at baseline colonoscopy. There are no longitudinal studies available on which to base surveillance intervals after resection. Our recommendation is based on low-quality evidence and will require updating when new data are available. The current evidence suggests that size (>10 mm), histology (a sessile serrated polyp is a more significant lesion than an HP; a sessile serrated polyp with cytological dysplasia is more advanced than a sessile serrated polyp without dysplasia), and location (proximal to the sigmoid colon) are risk factors that might be associated with higher risk of CRC. A sessile serrated polyp ≥10 mm and a sessile serrated polyp with cytological dysplasia should be managed like HRA (Table 1). Serrated polyps that are <10 mm and do not have cytological dysplasia may have lower risk and can be managed like LRA. |
|
Evidence for Recommendation 9 |
QoE: Quality of Evidence
High: High-Quality Evidence
Mod: Moderate-Quality Evidence
Mod-High: Moderate-High Quality Evidence
Low: Low-Quality Evidence
CRC: Colorectal cancer
HRA: High-risk adenoma
HPs: Hyperplastic polyps
FDR: First-degree relative
OR: Odds ratio
NCI: National Cancer Institute
HGD: High-grade dysplasia
CI: Confidence interval