British societies have always had their own postpolypectomy guidelines. Previous recommendations (compared to the U.S. Multi-Society Task Force on Colorectal Cancer recommendations used in the U.S.) had both a special higher risk group, for which 1-year surveillance was recommended, and a larger low-risk group.
The new British guideline uses the following definitions:
- The high-risk group requires 2 premalignant polyps of which ≥1 is advanced (a serrated polyp ≥10 mm or having dysplasia OR an adenoma ≥10 mm or with high-grade dysplasia) OR ≥5 premalignant polyps.
- “Premalignant” means any adenoma or serrated class polyp that is not a diminutive rectal hyperplastic polyp.
The key recommendations are:
- Patients without high-risk findings should return to routine screening (which relies on fecal blood screening).
- Patients with high-risk findings should have a “one-off” surveillance colonoscopy at 3 years.
- Patients with a nonpedunculated lesion that is ≥20 mm and removed piecemeal should have a site check at 2 to 6 months and 1 year after that.
- Surveillance should generally not occur if life expectancy is <10 years or in patients older than about 75 years.
- An exception to the above is a patient who is >10 years younger than the lower recommended screening age who is found to have polyps but no high-risk criteria; follow-up colonoscopy in 5 or 10 years can be considered.
It’s interesting to see how other countries handle postpolypectomy surveillance, and this is a very radical revision of previous guidelines. The authors estimate that the new guidelines will reduce the colonoscopy surveillance workload to 20% of its current level. One of the interesting consequences is that resect and discard is fully enabled because adenomas <10 mm and sessile serrated lesions and hyperplastic polyps <10 mm (with the exception of 1- to 5-mm rectal hyperplastic polyps) are all considered equivalent in the guideline.
Rutter MD, East J, Rees CJ, et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut
2019 Nov 27. (Epub ahead of print) (https://gut.bmj.com/content/69/2/201#block-system-main