Post-polypectomy surveillance

First surveillance interval

• 1-4 polyps:
  • High-risk individuals (any of the following features) should be scoped at 3 years
    • 1-2 tubular adenomas with HGD or tubulovilous or villous adenomas (with or without HGD), where the size of one or both is >=10mm
    • 3-4 tubular adenomas, where the size of one or more is >=10mm
    • 3-4 tubulovillous and/or villous adenomas and/or HGD, all <10mm
  • Mod-risk individuals (either of the following) should be scoped at 5 years
    • 1-2 tubular adenomas with HGD or tubulovillous or villous adenomas (with or without HGD), all of which are <10mm
    • 3-4 tubular adenomas without HGD, all of which are <10mm
  • Low-risk individuals (1-2 <10mm adenomas with no dysplasia) - next scope no sooner than 5 years (most surgeons suggest re-referral for a repeat scope at five years, despite guidelines recommending a repeat in 10 years)
• 5-9 conventional adenomas
  • 3 years if all TAs <10mm without HGD
  • 1 year if any adenoma >=10mm or with HGD and/or villosity
• >=10 adenomas
  • Surveillance 1 year regardless of size or histology
• Serrated adenomas:
  • Large sessile/laterally spreading lesions with en-bloc resection should have surveillance in 1 year

Piecemeal resection:

• Polyp >=20mm: repeat 3-6 months, then 12 months after that if the first repeat is ok
  • Examine site with multiple modalities, but no need to routinely biopsy at repeat scope

Indications for genetic counselling

• >=10 adenomas at one colonoscopy

Stop post-polypectomy endoscopic surveillance at 80yo

Do not routinely do shorter surveillance scopes in patients with a family history of CRC

Amount of villous components shouldn't affect screening interval.