Guidelines for Surveillance Intervals after Polypectomy: Coping with the Evidence
Authors: Thomas F. Imperiale
Journal: Annals of Internal Medicine (2008)

Editorials18 March 2008Guidelines for Surveillance Intervals after Polypectomy: Coping with the EvidenceThomas F. Imperiale, MD and Harold C. Sox, MD, EditorThomas F. Imperiale, MDFrom Indiana University, Indianapolis, IN 46202, and American College of Physicians, Philadelphia, PA 19106. and Harold C. Sox, MD, EditorFrom Indiana University, Indianapolis, IN 46202, and American College of Physicians, Philadelphia, PA 19106.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-6-200803180-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Economically advanced countries are having trouble coping with the consequences of advancing technology. They are asking how much health care is the right amount. The factors influencing how often to do surveillance colonoscopy after polypectomy encapsulate many elements of this debate. Patients are afraid of harboring undetected cancer, and physicians are afraid of missing an opportunity to prevent cancer. The resources devoted to surveillance colonoscopy may limit access to health care for other valid indications (1–3) and leave less to spend on disease prevention, prenatal care, or elementary school education. Finally, the evidence provides little guidance on optimal surveillance frequency.... References1. Boolchand V, Olds G, Singh J, Singh P, Chak A, Cooper GS. Colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Intern Med. 2006;145:654-9. [PMID: 17088578] LinkGoogle Scholar2. Mysliwiec PA, Brown ML, Klabunde CN, Ransohoff DF. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med. 2004;141:264-71. [PMID: 15313742] LinkGoogle Scholar3. Rex DK, Lieberman DA. Feasibility of colonoscopy screening: discussion of issues and recommendations regarding implementation [Editorial]. Gastrointest Endosc. 2001;54:662-7. [PMID: 11677497] CrossrefMedlineGoogle Scholar4. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O'Brien MJ, Levin B, et al; US Multi-Society Task Force on Colorectal Cancer. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872-85. [PMID: 16697750] CrossrefMedlineGoogle Scholar5. Winawer SJ, Zauber AG, O'Brien MJ, Ho MN, Gottlieb L, Sternberg SS, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993;328:901-6. [PMID: 8446136] CrossrefMedlineGoogle Scholar6. Jørgensen OD, Kronborg O, Fenger C. A randomized surveillance study of patients with pedunculated and small sessile tubular and tubulovillous adenomas. The Funen Adenoma Follow-up Study. Scand J Gastroenterol. 1995;30:686-92. [PMID: 7481533] CrossrefMedlineGoogle Scholar7. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992;84:1572-5. [PMID: 1404450] CrossrefMedlineGoogle Scholar8. Selby JV, Friedman GD, Quesenberry CP, Weiss NS. A case–control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653-7. [PMID: 1736103] CrossrefMedlineGoogle Scholar9. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658-62. [PMID: 1736104] CrossrefMedlineGoogle Scholar10. Lieberman DA, Weiss DG, Harford WV, Ahnen DJ, Provenzale D, Sontag SJ, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077-85. [PMID: 17698067] CrossrefMedlineGoogle Scholar11. Laiyemo AO, Murphy G, Albert PS, Sansbury LB, Wang Z, Cross AJ, et al. Postpolypectomy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. 2008;148:419-26. LinkGoogle Scholar12. Eide TJ. Risk of colorectal cancer in adenoma-bearing individuals within a defined population. Int J Cancer. 1986;38:173-6. [PMID: 3733258] CrossrefMedlineGoogle Scholar13. Loeve F, Boer R, Zauber AG, Van Ballegooijen M, Van Oortmarssen GJ, Winawer SJ, et al. National Polyp Study data: evidence for regression of adenomas. Int J Cancer. 2004;111:633-9. [PMID: 15239144] CrossrefMedlineGoogle Scholar14. Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:1009-13. [PMID: 3653628] CrossrefMedlineGoogle Scholar15. Barry EL, Baron JA, Grau MV, Wallace K, Haile RW. K-ras mutations in incident sporadic colorectal adenomas. Cancer. 2006;106:1036-40. [PMID: 16456810] CrossrefMedlineGoogle Scholar16. Einspahr JG, Martinez ME, Jiang R, Hsu CH, Rashid A, Bhattacharrya AK, et al. Associations of Ki-ras proto-oncogene mutation and p53 gene overexpression in sporadic colorectal adenomas with demographic and clinicopathologic characteristics. Cancer Epidemiol Biomarkers Prev. 2006;15:1443-50. [PMID: 16896030] CrossrefMedlineGoogle Scholar17. Maltzman T, Knoll K, Martinez ME, Byers T, Stevens BR, Marshall JR, et al. Ki-ras proto-oncogene mutations in sporadic colorectal adenomas: relationship to histologic and clinical characteristics. Gastroenterology. 2001;121:302-9. [PMID: 11487539] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Indiana University, Indianapolis, IN 46202, and American College of Physicians, Philadelphia, PA 19106.Disclosures: None disclosed.Corresponding Author: Thomas F. Imperiale, MD, Indiana University, Regenstrief Institute, 1050 Wishard Boulevard, Indianapolis, IN 46202.Current Author Addresses: Dr. Imperiale: Indiana University, Regenstrief Institute, 1050 Wishard Boulevard, Indianapolis, IN 46202.Dr. Sox: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPostpolypectomy Colonoscopy Surveillance Guidelines: Predictive Accuracy for Advanced Adenoma at 4 Years Adeyinka O. Laiyemo , Gwen Murphy , Paul S. Albert , Leah B. Sansbury , Zhuoqiao Wang , Amanda J. Cross , Pamela M. Marcus , Bette Caan , James R. Marshall , Peter Lance , Electra D. Paskett , Joel Weissfeld , Martha L. Slattery , Randall Burt , Frank Iber , Moshe Shike , J. Walter Kikendall , Elaine Lanza , and Arthur Schatzkin Should We Shorten or Lengthen Postpolypectomy Surveillance Intervals? Douglas K. Rex and Sidney J. Winawer Metrics Cited ByColorectal Cancer Screening Tests and RecommendationsColonoscopic Polypectomy, Mucosal Resection, and Submucosal DissectionClinical Trials in EuropeControversies in Cancer Screening: Focusing on Colorectal Cancer RecommendationsAdvanced vs. "High-Risk" Adenomas: Identifying the Relevant Target for CT Colonography ScreeningA Pooled Analysis of Advanced Colorectal Neoplasia Diagnoses After Colonoscopic PolypectomyFollow-up After Endoscopic PolypectomyShould We Shorten or Lengthen Postpolypectomy Surveillance Intervals?Douglas K. Rex, MD and Sidney J. Winawer, MD 18 March 2008Volume 148, Issue 6Page: 477-479KeywordsAdenomasClinical trialsColonoscopyColorectal cancerDrugsDysplasiaHealth careHistologyMutation ePublished: 18 March 2008 Issue Published: 18 March 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...