Preneoplastic Colorectal Polyps: “I Found Them and Removed Them—Now What?”
Authors: David S. Weinberg, Robert E. Schoen
Journal: Annals of Internal Medicine (2019)

Editorials5 November 2019Preneoplastic Colorectal Polyps: "I Found Them and Removed Them—Now What?"David S. Weinberg, MD, MSc and Robert E. Schoen, MD, MPHDavid S. Weinberg, MD, MScFox Chase Cancer Center, Philadelphia, Pennsylvania (D.S.W.) and Robert E. Schoen, MD, MPHUniversity of Pittsburgh, Pittsburgh, Pennsylvania (R.E.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2795 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail One of our mentors used to say, "There is an infinite amount of human disease—one only needs to search for it." But what happens when a finding that may indicate disease outstrips our knowledge of how to respond? Management of colorectal polyps is one such example. Increasing rates of screening; ever-improving, high-resolution endoscopes; and an emphasis on polyp detection as a measure of colonoscopy quality have increased the identification rate of preneoplastic adenomatous and serrated polyps. Some high-performing colonoscopy examiners now detect preneoplastic lesions in 50% to 60% of patients undergoing screening (1). Guidelines recommend that patients with preneoplastic polyps ...References1. Rex DK, Repici A, Gross SA, et al. High-definition colonoscopy versus Endocuff versus EndoRings versus full-spectrum endoscopy for adenoma detection at colonoscopy: a multicenter randomized trial. Gastrointest Endosc. 2018;88:335-344. [PMID: 29530353] doi:10.1016/j.gie.2018.02.043 CrossrefMedlineGoogle Scholar2. Dubé C, Yakubu M, McCurdy BR, et al. Risk of advanced adenoma, colorectal cancer, and colorectal cancer mortality in people with low-risk adenomas at baseline colonoscopy: a systematic review and meta-analysis. 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Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study. Gut. 2019;68:1642-52. [PMID: 30538097] doi:10.1136/gutjnl-2018-317297 CrossrefMedlineGoogle Scholar7. Jeon J, Du M, Schoen RE, et al; Colorectal Transdisciplinary Study and Genetics and Epidemiology of Colorectal Cancer Consortium. Determining risk of colorectal cancer and starting age of screening based on lifestyle, environmental, and genetic factors. Gastroenterology. 2018;154:2152-2164.e19. [PMID: 29458155] doi:10.1053/j.gastro.2018.02.021 CrossrefMedlineGoogle Scholar8. Joseph DA, Meester RG, Zauber AG, et al. Colorectal cancer screening: estimated future colonoscopy need and current volume and capacity. Cancer. 2016;122:2479-86. [PMID: 27200481] doi:10.1002/cncr.30070 CrossrefMedlineGoogle Scholar9. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68:250-81. [PMID: 29846947] doi:10.3322/caac.21457 CrossrefMedlineGoogle Scholar10. Ladabaum U, Mannalithara A, Meester RGS, et al. Cost-effectiveness and national effects of initiating colorectal cancer screening for average-risk persons at age 45 years instead of 50 years. Gastroenterology. 2019;157:137-48. [PMID: 30930021] doi:10.1053/j.gastro.2019.03.023 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Fox Chase Cancer Center, Philadelphia, Pennsylvania (D.S.W.)University of Pittsburgh, Pittsburgh, Pennsylvania (R.E.S.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2795.Corresponding Author: David S. Weinberg, MD, MSc, Department of Medicine, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111; e-mail, david.[email protected]edu.Current Author Addresses: Dr. Weinberg: Department of Medicine, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111.Dr. Schoen: University of Pittsburgh, 200 Lothrop Street, Mezzanine Level, C Wing, PUH, Pittsburgh, PA 15213-2582.This article was published at Annals.org on 24 September 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHigh-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas Reinier G.S. Meester , Iris Lansdorp-Vogelaar , Sidney J. Winawer , Ann G. Zauber , Amy B. Knudsen , and Uri Ladabaum Metrics Cited byDevelopment of a Large Colonoscopy-Based Longitudinal Cohort for Integrated Research of Colorectal Cancer: Partners Colonoscopy CohortColorectal cancer risk following polypectomy in a multicentre, retrospective, cohort study: an evaluation of the 2020 UK post-polypectomy surveillance guidelinesContribution of Surveillance Colonoscopy to Colorectal Cancer PreventionDoes Colon Surveillance After Polypectomy Prevent Colon Cancer and Save Lives?Is surveillance colonoscopy necessary for all patients with bowel polyps? 5 November 2019Volume 171, Issue 9Page: 667-668KeywordsAdenomasColonoscopyForecastingLesionsMortalityObservational studiesQuality adjusted life yearsRandomized trialsRetrospective studiesRisk assessments ePublished: 24 September 2019 Issue Published: 5 November 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...