European Society of Gastrointestinal Endoscopy

Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Authors: Cesare Hassan, Enrique Quintero, Jean-Marc Dumonceau, Jaroslaw Regula, Catarina Brandão, Stanislas Chaussade, Evelien Dekker, Mario Dinis-Ribeiro, Monika Ferlitsch, Antonio Gimeno-García, Yark Hazewinke, Rodrigo Jover, Mette Kalager, Magnus Loberg, Christian Pox, Bjorn Rembacken, David Lieberman

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Main recommendations

The following recommendations for post-polypectomy endoscopic surveillance should be applied only after a high quality baseline colonoscopy with complete removal of all detected neoplastic lesions.

1 In the low risk group (patients with 1–2 tubular adenomas<10mm with low grade dysplasia), the ESGE recommends participation in existing national screening programmes 10 years after the index colonoscopy. If no screening programme is available, repetition of colonoscopy 10 years after the index colonoscopy is recommended (strong recommendation, moderate quality evidence).

2 In the high risk group (patients with adenomas with villous histology or high grade dysplasia or ≥10mm in size, or ≥3 adenomas), the ESGE recommends surveillance colonoscopy 3 years after the index colonoscopy (strong recommendation, moderate quality evidence). Patients with 10 or more adenomas should be referred for genetic counselling (strong recommendation, moderate quality evidence).

3 In the high risk group, if no high risk adenomas are detected at the first surveillance examination, the ESGE suggests a 5-year interval before a second surveillance colonoscopy (weak recommendation, low quality evidence). If high risk adenomas are detected at first or subsequent surveillance examinations, a 3-year repetition of surveillance colonoscopy is recommended (strong recommendation, low quality evidence).

4 The ESGE recommends that patients with serrated polyps <10mm in size with no dysplasia should be classified as low risk (weak recommendation, low quality evidence). The ESGE suggests that patients with large serrated polyps (≥10mm) or those with dysplasia should be classified as high risk (weak recommendation, low quality evidence).

5 The ESGE recommends that the endoscopist is responsible for providing a written recommendation for the post-polypectomy surveillance schedule (strong recommendation, low quality evidence).

Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

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DOI http://dx.doi.org/10.1055/s-0033-1344548
Endoscopy 2013; 45: 842–851
© Georg Thieme Verlag KG Stuttgart· New York