Colonoscopic surveillance after polypectomy: Discussion

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Clinical Practice Guidelines for Surveillance Colonoscopy > Colonoscopic surveillance after polypectomy: Discussion


Surveillance intervals following the removal of conventional adenomas only

Unresolved issues

Long term outcomes following the removal of conventional adenomas are not well-described in the literature in the modern era of high quality colonoscopy. It is also unclear exactly which low risk individuals may benefit from shorter surveillance intervals. Studies of outcomes and surveillance intervals in routine endoscopy practice in Australia are lacking.

Studies currently underway

An important set of studies, the European PolypA small growth protruding from a mucous membrane, such as the lining of the bowel. Surveillance (EPoSEuropean Polyp Surveillance trials) trials[1], have commenced and will be a step forward in addressing gaps in the evidence base.

Future research priorities

More prospective contemporary studies incorporating high quality colonoscopy are needed, particularly in an Australian environment. Research on the efficacy of dissemination and implementation of these guidelines along with barriers and enablers would be valuable. There is a unique opportunity with these surveillance recommendations to comprehensively assess health outcomes, colonoscopy demand and cost implications to guide the further refinement of international surveillance intervals following removal of conventional adenomas. Compulsory colonoscopy and pathology data provision to a national database would facilitate the above research priorities.

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Surveillance intervals following the removal of serrated adenomas with or without synchronous conventional adenomas

Unresolved issues

The understanding of serrated adenomas in the era of modern high quality colonoscopy is evolving.

Studies currently underway

An important set of studies, the EPoSEuropean Polyp Surveillance trials trials[1], have commenced and will be a step forward in addressing gaps in the evidence base.

Future research priorities

These guidelines are the first internationally to consider surveillance intervals of conventional and serrated adenomas alone and in combination. There is an opportunity to set up observational trials to assess outcomes to inform international surveillance intervals over time.

The resourcing implications of separate recommendations for serrated polyps are important to establish. Research on the efficacy of dissemination and implementation of these guidelines along with barriers and enablers would be valuable.

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Surveillance intervals following the removal of large sessile and laterally spreading adenomas

Unresolved issues

High quality data in this area is lacking.

Studies currently underway

None

Future research priorities

Nil new

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Surveillance intervals for second and subsequent colonoscopies

Unresolved issues

The understanding of serrated adenomas in the era of modern high quality colonoscopy is evolving.

Studies currently underway

None known.

Future research priorities

These guidelines are the first internationally to consider second and subsequent surveillance intervals of conventional and serrated adenomas alone and in combination. There is an opportunity to set up observational trials to assess outcomes to inform international surveillance intervals over time. The resourcing implications of these changed recommendations are important to establish. Research into the efficacy of dissemination and implementation of these guidelines along with barriers and enablers would be valuable.

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References

  1. 1.01.1 Jover R, Bretthauer M, Dekker E, Holme Ø, Kaminski MF, Løberg M, et al. Rationale and design of the European Polyp Surveillance (EPoS) trials. Endoscopy 2016 Jun;48(6):571-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27042931.

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