Korean J Gastroenterol.  2012 Feb;59(2):99-117. 10.4166/kjg.2012.59.2.99.

Korean Guidelines for Post-polypectomy Colonoscopic Surveillance

Affiliations
  • 1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea. younghokim@skku.edu
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 6Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
  • 9Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea.
  • 10Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea.
  • 11Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 12Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

Abstract

Post-polypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. However, because the medical resource is limited, and the first screening colonoscopy produces the greatest effect on reducing the incidence and mortality of colorectal cancer, there is a need to increase the efficiency of postpolypectomy surveillance. In the present report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy. Based on the results of review of the evidences, we elucidated the high risk findings of the index colonoscopy as follows: 1) 3 or more adenomas, 2) any adenoma larger than 10 mm, 3) any tubulovillous or villous adenoma, 4) any adenoma with high-grade dysplasia, and 5) any serrated polyps larger than 10 mm. In patients without any high-risk findings at the index colonoscopy, surveillance colonoscopy should be performed five years after index colonoscopy. In patients with one or more high risk findings, surveillance colonoscopy should be performed three years after polypectomy. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polyp removal, the patient's general condition, and family and medical history. This practical guideline cannot totally take the place of clinical judgments made by practitioners and should be revised and supplemented in the future as new evidence becomes available.

Keyword

Colorectal polyp; Colonoscopy; Polypectomy; Surveillance; Guideline

MeSH Terms

Adenoma/*diagnosis/surgery
Adenoma, Villous/diagnosis/surgery
Colonic Polyps/pathology/*surgery
*Colonoscopy
Colorectal Neoplasms/*diagnosis/surgery
Databases, Factual
Humans
Republic of Korea
Risk Factors
Time Factors

Figure

  • Fig. 1 Flow chart outlining search process used to identify articles for inclusion in systematic review and meta-analysis.

  • Fig. 2 Forest plot for the number of colorectal adenomas as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom; HR, hazard ratio.

  • Fig. 3 Forest plot for the size of colorectal adenomas as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom; HR, hazard ratio.

  • Fig. 4 Forest plot for villous/tubulovillous adenomas as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom; HR, hazard ratio; TA, tubular adenoma; TVA, tubulovillous adenoma; VA, villous adenoma.

  • Fig. 5 Forest plot for adenomas with high grade dysplasia as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom; HR, hazard ratio; LGD, low grade dysplasia; HGD, High grade dysplasia.

  • Fig. 6 Forest plot of the large (≥10 mm) serrated polyps at index colonoscopy as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom.

  • Fig. 7 Forest plot for the location of index polyps as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom.

  • Fig. 8 Forest plot for the gender as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom; HR, hazard ratio.

  • Fig. 9 Forest plot for the family history of colorectal cancers as a risk factor for advanced neoplasia. SE, standard error; IV, inverse variance; df, degrees of freedom; HR, hazard ratio; FHx, family history.


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