Polyp surveillance intervals

Surveillance colonoscopy intervals after polypectomy, from the Cancer Council Australia clinical practice guidelines for surveillance colonoscopy (the 2018 edition, approved by the NHMRC on 7 December 2018). Use the size as documented by the endoscopist, once histology is known and the colon has been cleared of all significant neoplasia.

Which interval First surveillance, after one colonoscopy with findings 3rd colonoscopy, based on the two most recent colonoscopies

Colonoscopy findingsConventional adenomas number removed Any conventional adenoma 10 mm or larger Any high-grade dysplasia or villosity (tubulovillous or villous adenoma)Clinically significant serrated polypssessile serrated adenoma, traditional serrated adenoma, or hyperplastic polyp 10 mm or larger Any advanced serrated polyp (10 mm or larger, dysplasia, or traditional serrated adenoma)

Large sessile or laterally spreading lesion

None Removed en bloc Removed piecemeal

Other factors All adenomas diminutive (under 6 mm) Man with the metabolic syndrome Significant family history of colorectal cancer First degree relative with bowel cancer diagnosed under 50 Malignant polyp (T1 adenocarcinoma)Age years, optional

Enter the colonoscopy findings.

Tables used

Table 3, conventional adenomas only: by number (1–2, 3–4, 5–9, 10 or more), size (under or at least 10 mm) and high-grade dysplasia or villosity.
Table 9, clinically significant serrated polyps, alone or with conventional adenomas.
Large sessile and laterally spreading lesions: about 12 months after en bloc excision, about 6 months after piecemeal excision.
Tables 13 to 16, the 3rd colonoscopy, from the two most recent colonoscopies.
Table 17, age 75 or over: at 75 to 80 consider surveillance if the Charlson score is 4 or less; not recommended if the score is over 4, or over age 80.
Table 18, the simplified Charlson score for colonoscopy benefit: at 75 to 79 the score stays at 4 or less with at most one one-point condition and none of the heavier ones; at 80 or over it stays at 4 or less only with none of them.

Low-risk conventional adenoma: under 10 mm, tubular, without high-grade dysplasia. High-risk conventional adenoma: 10 mm or larger, high-grade dysplasia or villosity.

Reference

Cancer Council Australia Colonoscopy Surveillance Working Party. Clinical practice guidelines for surveillance colonoscopy. Sydney: Cancer Council Australia. Recommendations approved by the NHMRC on 7 December 2018.Guideline page