Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Abstract

Colonoscopy is performed routinely for colorectal cancer (CRC) screening, follow-up of other abnormal screening tests, workup of signs and symptoms of gastrointestinal disease, and surveillance after CRC and polyp removal. Post procedure, colonoscopists are expected to provide follow-up recommendations to patients and referring physicians. Recommendations for follow-up after normal colonoscopy among individuals age-eligible for screening, and post-polypectomy among all individuals with polyps are among the most common clinical scenarios requiring guidance.1 Risk of metachronous advanced neoplasia is associated with findings on prior colonoscopy. After high-quality colonoscopy, patients with no neoplasia detected are at the lowest risk, and those with polyps are risk-stratified based on the histology, number, location, and size of polyps detected. Since the release of the last US Multi-Society Task Force (Task Force) recommendations for post-colonoscopy follow-up and polyp surveillance in 2012,2 a number of articles have been published on risk of CRC based on colonoscopy findings and patient characteristics, as well as the potential impact of screening and surveillance colonoscopy on outcomes, such as incident CRC and polyps. Further, recent studies increasingly reflect the modern era of colonoscopy with more awareness of the importance of quality factors (eg, adequate bowel preparation, cecal intubation, adequate adenoma detection, and complete polyp resection), and utilization of state of the art technologies (eg, high-definition colonoscopes). Higher-quality colonoscopy could impact the importance of previously identified risk factors. Our aim was to review newly available evidence and update recommendations for follow-up after colonoscopy with or without polypectomy. Methods Evidence Review and Recommendation Development To identify issues of greatest importance for the current revision, we developed PICO (patient, intervention, comparison, and outcome) questions (Supplementary Appendix A, https://links.lww.com/AJG/B394 [SG and DL, with input from TK]). In consultation with a certified medical librarian (KH), literature searches were performed in PubMed, Embase, and CINAHL with a combination of controlled vocabulary and keyword terms for colonoscopy, polyps, and polypectomy surveillance (see Supplementary Appendix B, https://links.lww.com/AJG/B395 for search terms). English-language articles since January 1, 2012 were retrieved. Searches were run on March 30, 2017, and identified a total of 1904 unique articles (see Supplementary Appendix C, https://links.lww.com/AJG/B396 for article selection flow). Criteria used for inclusion/exclusion of titles, abstracts, and articles are outlined in Table 1. All titles were reviewed by a single author (SG) and potentially relevant titles were selected for abstract review. All abstracts were reviewed by 2 authors (SG and DL) and potentially relevant abstracts were selected for full article review. Included articles were reviewed in detail by the same 2 authors. The final list of articles selected for review was supplemented by repeating the literature search through September 2018 to identify articles published since the time of the literature search, as well as through opportunistic identification of additional relevant articles. References directly relevant to final recommendations were identified through joint consensus (SG and DL). Based on prior findings and the current literature review, post-colonoscopy management recommendations were developed by 2 authors (SG and DL) and refined through consensus discussion with all authors after circulating both draft recommendations and a table summarizing key findings of articles that were included for article review. For each recommendation, the quality of evidence (Table 2) and strength of recommendation were previously recommendations that most patients the management and that with patients recommendations that to and and that is in with and Criteria for of and of Recommendations and of article recommendations for follow-up for individuals with CRC (eg, and bowel disease, a of CRC of CRC or colorectal or recommendations for follow-up after colonoscopy and polypectomy to in polyp findings in a colonoscopy based on the of clinical Further, recommendations for polypectomy were the of the Task Force recommendations for follow-up colonoscopy for individuals with and a of Recommendations for follow-up of management of patients with a as well as polypectomy in Task Force The of colonoscopy screening and post-polypectomy surveillance are to CRC and provide a review of the available evidence on the impact of surveillance on we provide recommendations for follow-up with a of of the quality of evidence and strength of is by a of key of and for in the the of on post-colonoscopy we on since the Task Force recommendations in and Colonoscopy terms and The polyp surveillance literature in terms used for and and associated (Table In no