What should be the surveillance colonoscopy following sessile and laterally spreading adenomas?

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What should be the surveillance colonoscopy following sessile and laterally spreading adenomas?

High rates of residual adenoma are identified following a piecemeal resection of large (generally regarded as >2cm in size) and sessile adenomas.[1][2][3][4][5] If there is doubt about whether the index lesion has been totally removed, the next colonoscopy should be done within three to six months.

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Evidence summary and recommendations

Evidence summary Level References
High rates of residual adenoma are identified following a piecemeal resection of large and sessile adenomas leading in some cases to doubts about total removal of the index lesion. III-1 [1], [3], [4]


Recommendation Grade
If large and sessile adenomas are removed piecemeal, follow-up colonoscopy should be at three to six months and again at twelve months to ensure complete removal. If removal is complete, subsequent surveillance should then be based on histological findings, size and number of other adenomas (as set out in What should be the surveillance colonoscopy for patients at low risk (1-2 small tubular <10mm adenomas)? and What should be the surveillance colonoscopy for patients at high risk (>2 and ≥10mm adenomas or with HGD)?).
B

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References

  1. 1.0 1.1 Salama M, Ormonde D, Quach T, Ee H, Yusoff I. Outcomes of endoscopic resection of large colorectal neoplasms: an Australian experience J Gastroenterol Hepatol 2010 Jan;25(1):84-9 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19793173].
  2. Jørgensen OD, Kronborg O, Fenger C, Rasmussen M. Influence of long-term colonoscopic surveillance on incidence of colorectal cancer and death from the disease in patients with precursors (adenomas) Acta Oncol 2007;46(3):355-60 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17450471].
  3. 3.0 3.1 Khashab M, Eid E, Rusche M, Rex DK. Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas Gastrointest Endosc 2009 Aug;70(2):344-9 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19249767].
  4. 4.0 4.1 Seitz U, Bohnacker S, Seewald S, Thonke F, Soehendra N. Long-term results of endoscopic removal of large colorectal adenomas Endoscopy 2003 Aug;35(8):S41-4 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12929053].
  5. Jass JR, Young J, Leggett BA. Hyperplastic polyps and DNA microsatellite unstable cancers of the colorectum Histopathology 2000 Oct;37(4):295-301 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11012735].

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Appendices

View body of evidence View body of evidence View initial literature search View literature search documentation