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Primer: applying the new postpolypectomy surveillance guidelines in clinical practice

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 571–578 (2007)Cite this article

Abstract

Colonoscopy is being increasingly used for colorectal cancer screening, which has resulted in a growing cohort of patients who have polyps that require postpolypectomy surveillance. Risk stratification enables postpolypectomy surveillance to be tailored to individual patient needs, and this is one of the fundamental points emphasized by the unified US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society (USMSTF–ACS) guidelines. Most patients do not require intensive surveillance; those patients who have one or two small (<1 cm) adenomas can safely undergo repeat colonoscopy after 5–10 years. Consensus guidelines that merge the recommendations of all societies are more user-friendly than individual guidelines, decrease confusion, and eliminate conflicting recommendations that are a barrier to guideline uptake. Nonetheless, studies have shown that specialists and nonspecialists overutilize colonoscopy for postpolypectomy surveillance, which places a large burden on already strained resources. Barriers to guideline implementation include factors involving the patient, physician, and health-care system. Physician education and widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application.

Key Points

  • Colonoscopy is being increasingly used for colorectal cancer screening, which has resulted in a growing cohort of patients who have polyps and require postpolypectomy surveillance

  • The goal of postpolypectomy surveillance is to prevent the development of significant metachronous adenomas and cancers

  • The frequency of the surveillance that is required depends on an accurate assessment of the individual patient's risk of developing subsequent colonic neoplasms

  • Despite the development of the consensus guidelines on postpolypectomy surveillance (such as the unified USMSTF–ACS guidelines), many specialists and non-specialists overutilize colonoscopy for postpolypectomy surveillance

  • Physician education and widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application

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Acknowledgements

We thank Thomas Emmett, MD, for his help in conducting a thorough literature search. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. CJ Kahi is an Assistant Professor of Medicine and DK Rex is a Professor of Medicine in the Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.,

    Charles J Kahi & Douglas K Rex

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Correspondence to Charles J Kahi.

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Kahi, C., Rex, D. Primer: applying the new postpolypectomy surveillance guidelines in clinical practice. Nat Rev Gastroenterol Hepatol 4, 571–578 (2007). https://doi.org/10.1038/ncpgasthep0932

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