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CA Cancer J Clin 2006; 56:143-159
doi: 10.3322/canjclin.56.3.143
© 2006 American Cancer Society
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 Guidelines for Colonoscopy Surveillance after Polypectomy
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Guidelines for Colonoscopy Surveillance after Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society*,,{dagger}

Sidney J. Winawer, MD, Ann G. Zauber, PhD, Robert H. Fletcher, MD, MSc, Jonathon S. Stillman, MD, Michael J. O’Brien, MD, MPH, Bernard Levin, MD, Robert A. Smith, PhD, David A. Lieberman, MD, Randall W. Burt, MD, Theodore R. Levin, MD, John H. Bond, MD, Durado Brooks, MD, MPH, Tim Byers, MD, MPH, Neil Hyman, MD, Lynne Kirk, MD, Alan Thorson, MD, Clifford Simmang, MD, David Johnson, MD and Douglas K. Rex, MD


Dr. Winawer is Paul Sherlock Chair in Medicine, Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
Dr. Zauber is Associate Attending Biostatistician, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
Dr. Fletcher is Professor, Ambulatory Care and Prevention, Harvard Medical School, Boston, MA.
Dr. Stillman is Gastroenterology Fellow, Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
Dr. O’Brien is Professor, Medical Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA.
Dr. B. Levin is Vice President, Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX.
Dr. Smith is Director, Cancer Screening, Cancer Control Science Department, American Cancer Society, Atlanta, GA.
Dr. Lieberman is Chief, Division of Gastroenterology, Oregon Health and Science University, Portland, OR.
Dr. Burt is Interim Executive Director, Huntsman Cancer Institute; and Professor of Medicine, University of Utah, Salt Lake City, UT.
Dr. T.R. Levin is Associate Chief, Gastroenterology Department, Kaiser Permanente Medical Center, Walnut Creek, CA.
Dr. Bond is Professor of Medicine, University of Minnesota; and Chief, Gastroenterology, Minneapolis VA Medical Center, Minneapolis, MN.
Dr. Brooks is Director, Prostate and Colorectal Cancer, Cancer Control Science Department, American Cancer Society, Atlanta, GA.
Dr. Byers is Program Leader, Clinical Cancer Prevention and Control; and Professor, Department of Epidemiology, University of Colorado, Denver, CO.
Dr. Hyman is Chief, General Surgery, University of Vermont, Burlington, VT.
Dr. Kirk is Tim and Toni Hartman Professor, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Dr. Thorson is Clinical Associate Professor of Surgery, Creighton University School of Medicine and the University of Nebraska College of Medicine; and Program Director, Section of Colon and Rectal Surgery, Creighton University, Omaha, NE.
Dr. Simmang is Associate Professor of Surgery, Department of Colon and Rectal Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Dr. Johnson is Professor of Medicine; and Chief, Gastroenterology, Eastern Virginia School of Medicine, Norfolk, VA.
Dr. Rex is Chair, US Multi-Society Task Force on Colorectal Cancer; and Professor of Medicine, Indiana University School of Medicine, Indianapolis, IN.
This article is available online at http://CAonline.AmCancerSoc.org

Adenomatous polyps are the most common neoplastic findings uncovered in people who undergo colorectal screening or have a diagnostic workup for symptoms. It was common practice in the 1970s for these patients to have annual follow-up surveillance examinations to detect additional new adenomas as well as missed synchronous adenomas. As a result of the National Polyp Study report in 1993, which demonstrated clearly in a randomized design that the first postpolypectomy examination could be deferred for 3 years, guidelines published by a gastrointestinal consortium in 1997 recommended that the first follow-up surveillance be 3 years after polypectomy for most patients. In 2003, these guidelines were updated, colonoscopy was recommended as the only follow-up examination, and stratification at baseline into lower and higher risk for subsequent adenomas was suggested. The 1997 and 2003 guidelines dealt with both screening and surveillance. However, it has become increasingly clear that postpolypectomy surveillance is now a large part of endoscopic practice, draining resources from screening and diagnosis. In addition, surveys have demonstrated that a large proportion of endoscopists are conducting surveillance examinations at shorter intervals than recommended in the guidelines. In the present paper, a careful analytic approach was designed addressing all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be more definitely stratified at their baseline colonoscopy into those at lower or increased risk for a subsequent advanced neoplasia. People at increased risk have either three or more adenomas, or high-grade dysplasia, or villous features, or an adenoma ≥1 cm in size. It is recommended that they have a 3-year follow-up colonoscopy. People at lower risk who have one or two small (<1 cm) tubular adenomas with no high-grade dysplasia can have a follow up in 5 to 10 years, whereas people with hyperplastic polyps only should have a 10-year follow up as average-risk people. Recent papers have reported a significant number of missed cancers by colonoscopy. However, high-quality baseline colonoscopy with excellent patient preparation and adequate withdrawal time should minimize this and reduce clinicians’ concerns. These guidelines were developed jointly by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society to provide a broader consensus and thereby increase utilization of the recommendations by endoscopists. Adoption of these guidelines nationally can have a dramatic impact on shifting available resources from intensive surveillance to screening. It has been shown that the first screening colonoscopy and polypectomy produces the greatest effects on reducing the incidence of colorectal cancer in patients with adenomatous polyps.




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