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Guidelines for Surveillance Colonoscopy

Choosing Wisely®  Colonoscopy:  When you need it - When you don't

Guidelines for Surveillance Colonoscopy

  • Routine baseline colonoscopy with good to excellent prep; no precancerous polyps, no significant family history or advanced polyps:  Interval to next exam is 10 years.
  • Small rectal hyperplastic polyps:  Colonoscopy or other screening options at intervals recommended for average-risk individuals.
  • Single first-degree relative with CRC or advanced adenoma (adenoma > or = 10 mm in size, with high-grade dysplasia or villous elements) diagnosed at age > or = 60 years:  Same screening as average risk (colonoscopy every 5-10 years beginning at 50)
  • Single first-degree relative with CRC or advanced adenoma diagnosed at age < 60 years or two first-degree relatives with CRC or advanced adenomas:  Colonoscopy every 5 years beginning at age 40, or 10 years younger than age at diagnosis of the youngest affected relative.
  • 1 or 2 small tubular adenomas:  Interval to next exam is 5 to 10 years after the initial polypectomy.
  • 3 to 10 adenomas or 1 adenoma > of 10 mm or any adenoma with villous features or high-grade dysplasia:  Interval to next exam is 1-3 years after the initial polypectomy.
  • > 10 adenomas on a single examination: < 3 years after the initial polypectomy.
  • Patients with colon and rectal cancer should undergo high-quality perioperative clearing: 3 to 6 months after cancer resection, if no unresectable metastases are found during surgery; alternatively, colonoscopy can be performed intraoperatively
  • Patients undergoing curative resection for colon or rectal cancer:  1 year after the resection (or 1 year following the performance of the colonoscopy that was performed to clear the colon of synchronous disease).
  • Large benign sessile polyp (> or = 10 mm):  Tattooing at the site should be considered if there is any question of incomplete resection.  Interval to first follow-up exam is 3-6 months to check for complete resection.  Repeat examinations are performed until the area is determined to be clear of neoplasia.  After the area is judged to be clear, the next exam is generally 1 year.  At the discretion of the examiner, earlier follow-up may be indicated.  Surgery or further endoscopic ablation may be needed if the polyp cannot be removed entirely.  Some studies have shown that the use of APC reduces recurrence of polyp tissue at the site.
  • Inflammatory bowel disease, chronic ulcerative colitis, and Crohn’s colitis:  Cancer risk begins to be significant 8 years after the onset of pancolitis or 12 to 15 years after the onset of left-sided colitis.  Colonoscoy with biopsies every 1-2 years.
  • African-Americans should be screened initially at 45 years due to the higher risk of CRC.
  • Genetic diagnosis of FAP or suspected FAP without genetic testing evidence.  Annual flexible sigmoidoscopy to determine if individual is expressing the genetic abnormality beginning at age 10-12.  If genetic test is positive, consider colectomy.

Attenuated FAP:

  •  Usually <100 adenomas and may have only a few
  •  May have >100 if first diagnosed >45 years of age
  •  Adenomas and carcinomas 60-75% right sided
  •  Mean age of carcinoma 55 years
  •  90% lack detectable APC mutations
  •  18-30% of APC mutation negative attenuated FAP may instead be due to MUTYH mutation
  • Colonoscopy every 1-3 years beginning at age 18

Surveillance colonoscopy may be discontinued when a patient’s age or co-morbid medical conditions would limit life expectancy to less than 10 years.

The above recommendations may be modified for high-risk patients.  Specifically:  Family history of familial adenomatous polyposis, family history of hereditary non-polyposis colon cancer, and inflammatory bowel disease.

Please see American Cancer Society Guidelines (3/2008).