Released on Feb 19, 2020

GI Societies Issue Updated Colorectal Cancer Screening Recommendations

These evidence-based recommendations support closer follow-up after colonoscopy screenings for some groups, less intense follow-up for others, and provide guidance for removing colorectal polyps.

Bethesda, Maryland (Feb. 18, 2020) – Patients at average risk of colorectal cancer who have a normal colonoscopy do not need to repeat screening for 10 years. It is common for polyps to be removed and tested during a colonoscopy, but the amount and size of polyps removed will change the patient’s follow-up screening schedule. In two new publications from the U.S. Multisociety Task Force (MSTF) on Colorectal Cancer, experts provide a timeline for patients to be rechecked for colorectal cancer based on their initial colonoscopy as well as recommendations for physicians to apply the safest and most effective techniques to completely remove polyps.

Colorectal cancer, the second leading cause of cancer death in the U.S., is preventable when precancerous polyps are found and removed before they turn into cancer. Screening for average-risk patients is recommended to begin at age 50. The recommendation documents from the U.S. Multisociety Task Force — which is comprised of representatives of the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy — aim to improve colorectal cancer prevention and early detection.

Recommendations for Follow-Up After Colonoscopy and Polypectomy1

For this publication, the U.S. MSTF reviewed their 2012 recommendations2 and provide an updated schedule for follow-up colonoscopy following a patient’s initial high-quality exam:

Patient has diminutive (≤ 5mm) and small (6-9mm) polyp(s) Recommend cold snare polypectomy
Patient has non-pedunculated (≥ 20mm) polyp(s) Recommend endoscopic mucosal resection
 Recommend snare resection of all grossly visible tissue of a polyp in a single colonoscopy session and in the safest minimum number of pieces
 Recommend against the use of ablative techniques on endoscopically visible residual tissue of a polyp
 Recommend the use of adjuvant thermal ablation of the post-EMR margin where no endoscopically visible adenoma remains despite meticulous inspection
Patient has pedunculated polyp(s) Recommend prophylactic mechanical ligation of the stalk with a detachable loop or clips on pedunculated polyps with head ≥20mm or with stalk thickness ≥5mm to reduce immediate and delayed post-polypectomy bleeding

To review all MSTF recommendations for patient follow-up, review the full publication

Recommendations for Endoscopic Removal of Colorectal Lesions3

In this publication, the U.S. MSTF provides best practices for the endoscopic removal of precancerous colorectal polyps during colonoscopy, which is called a polypectomy.

Best practices for polyp assessment and description

MSTF recommends macroscopic characterization of a polyp, which provides information to facilitate the polyp’s histologic prediction, and optimal removal strategy.

Best practices for polyp removal

The primary aim of polypectomy is complete removal of the colorectal lesion, and the subsequent prevention of colorectal cancer. Overall, the vast majority of benign colorectal lesions can be safely and effectively removed using endoscopic removal techniques.  When an endoscopist encounters a suspected benign colorectal polyp that he/she is not confident to completely remove, MSTF recommends referral to an endoscopist experienced in advanced polypectomy for subsequent evaluation and management in lieu of referral for surgery.

Patient has diminutive (≤ 5mm) and small (6-9mm) polyp(s) Recommend cold snare polypectomy
Patient has non-pedunculated (≥ 20mm) polyp(s) Recommend endoscopic mucosal resection
 Recommend snare resection of all grossly visible tissue of a polyp in a single colonoscopy session and in the safest minimum number of pieces
 Recommend against the use of ablative techniques on endoscopically visible residual tissue of a polyp
 Recommend the use of adjuvant thermal ablation of the post-EMR margin where no endoscopically visible adenoma remains despite meticulous inspection
Patient has pedunculated polyp(s) Recommend prophylactic mechanical ligation of the stalk with a detachable loop or clips on pedunculated polyps with head ≥20mm or with stalk thickness ≥5mm to reduce immediate and delayed post-polypectomy bleeding

 

Best practices for surveillance

MSTF recommends intensive follow-up schedule in patients following piecemeal endoscopic mucosal resection (lesions ≥ 20 mm) with the first surveillance colonoscopy at 6 months, and the intervals to the next colonoscopy at 1 year, and then 3 years.

To review all MSTF recommendations on polyp removal, review the full publication.

Task force members:

  • Joseph C. Anderson, MD, MHCDS, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
  • Carol A. Burke, MD, Cleveland Clinic, Ohio
  • Jason A. Dominitz, MD, MHS, University of Washington Medicine, Seattle
  • Samir Gupta, MD, MSc, University of California San Diego
  • Tonya R. Kaltenbach, MD, MS, University of California San Francisco
  • David A. Lieberman, MD, Oregon Health and Science University, Portland
  • Douglas K. Rex, MD, Indiana University School of Medicine, Indianapolis
  • Douglas J. Robertson, MD, MPH, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
  • Aasma Shaukat, MD, MPH, Minneapolis VA Health Care System, Minnesota
  • Sapna Syngal, MD, MPH, Dana-Farber Cancer Institute, Boston, Massachusetts

The U.S. MSTF recommendations are published jointly in Gastroenterology, The American Journal of Gastroenterology, and Gastrointestinal Endoscopy

References:

  1. Gupta S., Lieberman, D.A., Anderson, J.C. et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020. Epub ahead of print.
  2. Lieberman, D.A., Rex, D.K., Winawer, S.J. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012; 143: 844–857
  3. Kaltenbach, T., Anderson, J.C., Burke, C.A. et al. Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020. Epub ahead of print.

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About the American College of Gastroenterology

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 14,000 individuals from 85 countries. The ACG will be the preeminent champion for prevention, diagnosis and treatment of digestive disorders by facilitating the highest quality, compassionate and evidence-based patient care. www.gi.org. Follow ACG on Twitter @AmCollegeGastro.

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. www.gastro.org. AGA is now on Instagram. Like AGA on Facebook. Follow us on Twitter @AmerGastroAssn. Check out our videos on YouTube. Join AGA on LinkedIn.

About the American Society for Gastrointestinal Endoscopy

Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and  www.screen4coloncancer.org for more information and to find a qualified doctor in your area. Connect with ASGE on Twitter @ASGEendoscopy, and on LinkedIn and Facebook.

 


About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.

 

American Society for Gastrointestinal Endoscopy
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ALee@asge.org