Practice Guidelines

Colonoscopy Follow-up: U.S. Multi-Society Task Force on Colorectal Cancer Updates Recommendations

 

Am Fam Physician. 2021 Mar 1;103(5):314-316.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Adenomas on initial colonoscopy affect ongoing follow-up screening recommendations.

• A single normal colonoscopy demonstrates a lifetime CRC mortality risk 68% lower than in the general population.

• Finding more than 10 adenomas confers the highest risk, and repeat colonoscopy is recommended in one year.

• Finding polyps larger than 10 mm, between five and 10 sessile serrated polyps or adenomas, polyps with dysplasia, or traditional serrated adenomas confers high risk, and repeat colonoscopy is recommended in three years.

From the AFP Editors

Screening colonoscopy findings define the future risk of colorectal cancer (CRC) and the need for repeat screening. The U.S. Multi-Society Task Force on Colorectal Cancer updated recommended follow-up intervals after screening colonoscopy in average-risk individuals. This guidance does not apply to people with hereditary syndromes that increase CRC risk, inflammatory bowel disease, serrated polyposis syndrome, or personal or family history of CRC. Although tobacco use, rural living, metabolic syndrome, obesity, and aspirin use affect CRC risk, they do not influence recommended screening intervals.

Adequate Study

The task force defines an adequate study as a high-quality colonoscopy, which requires bowel preparation sufficient to visualize all polyps larger than 5 mm, examination to the cecum, and complete excision of all polyps found. Physicians who perform high-quality colonoscopies should detect adenomas in more than 30% of men and 20% of women who are screened.

Colonoscopy Findings Determine Risk

Common findings on colonoscopy reports include adenomas and polyps. Instead of defining high- and low-risk findings, task force recommendations depend on the number and size of findings.

When patients have had more than one colonoscopy, adenomas on initial colonoscopy are the most significant indicator of risk, affecting ongoing follow-up screening recommendations. Recommended intervals for screening based on the current findings may be shortened if a previous colonoscopy showed higher risk. The guideline includes recommendations based on limited evidence for a second follow-up depending on findings of the initial and original follow-up colonoscopies (Table 1).

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TABLE 1.

Follow-up Recommendations After High-Quality Colonoscopy

Initial colonoscopy findingFollow-up interval, yearsFollow-up colonoscopy findingFollow-up interval, years

Normal (no polyps)

10

Traditional adenomas

Tubular adenomas < 10 mm

1 to 2

7 to 10

Normal

10

Tubular adenomas < 10 mm

  1 to 2

7 to 10

  3 to 4

3 to 5

  5 to 10

3

High-risk adenoma

3

3 to 4

3 to 5

Normal

10

Tubular adenomas < 10 mm

  1 to 2

7 to 10

  3 to 4

3 to 5

  5 to 10

3

High-risk adenoma

3

5 to 10

3

No evidence available

High-risk adenoma ≥ 10 mm or villous or tubulovillous histology, or high-grade dysplasia

3

Normal

5

Tubular adenomas < 10 mm

  1 to 2

5

  3 to 4

3 to 5

  5 to 10

3

High-risk adenoma

3

> 10

1

No evidence available

Serrated polyps

Sessile serrated polyps < 10 mm

1 to 2

5 to 10

No evidence available

3 to 4

3 to 5

No evidence available

5 to 10

3

No evidence available

High-risk sessile serrated polyp ≥ 10 mm or dysplasia

3

No evidence available

Hyperplastic polyps

Up to 20 polyps < 10 mm

10

No evidence available

Any polyps ≥ 10 mm

3 to 5

No evidence available

Traditional serrated adenoma

3

No evidence available


Adapted with permission from Gupta S, Lieberman D, Anderson JC, 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;158(4):1136, 1137, 1144.

TABLE 1.

Follow-up Recommendations After High-Quality Colonoscopy

Initial colonoscopy findingFollow-up interval, yearsFollow-up colonoscopy findingFollow-up interval, years

Normal (no polyps)

10

Traditional adenomas

Tubular adenomas < 10 mm

1 to 2

7 to 10

Normal

10

Tubular adenomas < 10 mm

  1 to 2

7 to 10

  3 to 4

3 to 5

  5 to 10

3

High-risk adenoma

3

3 to 4

3 to 5

Normal

10

Tubular adenomas < 10 mm

  1 to 2

7 to 10

  3 to 4

3 to 5

  5 to 10

3

High-risk adenoma

3

5 to 10

3

No evidence available

High-risk adenoma ≥ 10 mm or villous or tubulovillous histology, or high-grade dysplasia

3

Normal

5

Tubular adenomas < 10 mm

  1 to 2

5

  3 to 4

3 to 5

  5 to 10

3

High-risk adenoma

3

> 10

1

No evidence available

Serrated polyps

Sessile serrated polyps < 10 mm

1 to 2

5 to 10

No evidence available

3 to 4

3 to 5

No evidence available

5 to 10

3

No evidence available

High-risk sessile serrated polyp ≥ 10 mm or dysplasia

3

No evidence available

Hyperplastic polyps

Up to 20 polyps < 10 mm

10

No evidence available

Any polyps ≥ 10 mm

3 to 5

No evidence available

Traditional serrated adenoma

3

No evidence available


Adapted with permission from Gupta S, Lieberman D, Anderson JC, et al. Recommendations

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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