Postpolypectomy Colonoscopy Surveillance

Kim, Hyun Soo

Abstract

Colonoscopy and polypectomy are increasingly being used as the most effective interventions for preventing colorectal cancer (CRC), which has resulted in a growing cohort of patients who require postpolypectomy surveillance (PPS). The goal of PPS is to prevent the development of significant metachronous adenomas and CRCs. The surveillance interval depends on an accurate assessment of the individual patient's risk of developing subsequent colonic neoplasm. The newly developed consensus guidelines (CG) emphasize the concept of 'risk stratification' and these guidelines are more user-friendly than the previous ones, thus eliminate conflicting recommendations that are a barrier to physicians using the guideline. Despite the development of CGs, many specialists and non-specialists overutilize colonoscopy for PPS, which causes an ineffective large burden of cost and it strains already limited resources. The safest and most cost-effective approach by colonoscopists to preventing CRC is to maximize the effectiveness of colonoscopy for clearing the colon and then follow the recommended intervals between procedures, including extended intervals for the low-risk cohorts. Educating colonoscopists and the widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application.