Korean Guidelines for Post-polypectomy Colonoscopic Surveillance

Abstract

Post-polypectomy surveillance has become a major indication for colonoscopy as a result of increased use ofscreening colonoscopy in Korea. However, because the medical resource is limited, and the first screeningcolonoscopy produces the greatest effect on reducing the incidence and mortality of colorectal cancer, there is aneed to increase the efficiency of postpolypectomy surveillance. In the present report, a careful analytic approachwas used to address all available evidences to delineate the predictors for advanced neoplasia at surveillancecolonoscopy. Based on the results of review of the evidences, we elucidated the high risk findings of the indexcolonoscopy as follows: 1) 3 or more adenomas, 2) any adenoma larger than 10 mm, 3) any tubulovillous or villousadenoma, 4) any adenoma with high-grade dysplasia, and 5) any serrated polyps larger than 10 mm. In patientswithout any high-risk findings at the index colonoscopy, surveillance colonoscopy should be performed five yearsafter index colonoscopy. In patients with one or more high risk findings, surveillance colonoscopy should beperformed three years after polypectomy. However, the surveillance interval can be shortened considering the qualityof the index colonoscopy, the completeness of polyp removal, the patient’s general condition, and family and medicalhistory. This practical guideline cannot totally take the place of clinical judgments made by practitioners and shouldbe revised and supplemented in the future as new evidence becomes available.