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Endoscopy 2009; 41(3): 209-217
DOI: 10.1055/s-0028-1119646
DOI: 10.1055/s-0028-1119646
Original article
© Georg Thieme Verlag KG Stuttgart · New York
Appropriateness of colonoscopy in Europe (EPAGE II) – Surveillance after polypectomy and after resection of colorectal cancer
Weitere Informationen
Publikationsverlauf
submitted17 June 2009
accepted after revision5 December 2009
Publikationsdatum:
11. März 2009 (online)
Background and study aims: To summarize the published literature on assessment of appropriateness of colonoscopy for surveillance after polypectomy and after curative-intent resection of colorectal cancer (CRC), and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II.
Methods: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of surveillance colonoscopy after polypectomy and after resection of CRC was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions.
Results: Most CRCs arise from adenomatous polyps. The characteristics of removed polyps, especially the distinction between low-risk adenomas (1 or 2, small [< 1 cm], tubular, no high-grade dysplasia) vs. high-risk adenomas (large [≥ 1 cm], multiple [> 3], high-grade dysplasia or villous features), have an impact on advanced adenoma recurrence. Most guidelines recommend a 3-year follow-up colonoscopy for high-risk adenomas and a 5-year colonoscopy for low-risk adenomas. Despite the lack of evidence to support or refute any survival benefit for follow-up colonoscopy after curative-intent CRC resection, surveillance colonoscopy is recommended by most guidelines. The timing of the first surveillance colonoscopy differs. The expert panel considered that 56 % of the clinical indications for colonoscopy for surveillance after polypectomy were appropriate. For surveillance after CRC resection, it considered colonoscopy appropriate 1 year after resection.
Conclusions: Colonoscopy is recommended as a first-choice procedure for surveillance after polypectomy by all published guidelines and by the EPAGE II criteria. Despite the limitations of the published studies, colonoscopy is also recommended by most of the guidelines and by EPAGE II criteria for surveillance after curative-intent CRC resection.
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1 See Appendix: The EPAGE II Study Group
F. FroehlichMD
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- The following figures and tables are available online:
Fig. e1 Colonoscopic surveillance in asymptomatic people after adenoma removal. Other considerations include age, comorbidity, and family history.
Fig. e2b Appropriateness ratings of clinical indications for performing colonoscopy for surveillance after polypectomy (full decision tree).
Fig. e3b Appropriateness ratings of clinical indications for performing colonoscopy for surveillance after curative-intent resection of colorectal cancer (CRC) (full decision tree).
Table e1 Diagnostic yield of surveillance colonoscopy after polypectomy.
Table e2 Risk factors at baseline colonoscopy for advanced adenomas at surveillance colonoscopy.
Table e3 Impact of polypectomy and colonoscopic surveillance on colorectal cancer (CRC) incidence and mortality.
Table e4 Guidelines for colonoscopy surveillance after polypectomy.
Table e5 Diagnostic yield of colonoscopy surveillance programs after curative resection of colorectal cancer (CRC).
Table e6 a Local recurrence rates of colorectal cancer (CRC) according to primary tumor stage (5-year overall rate). b Cancer classifications. c Tumor–node–metastasis (TNM) definitions.
Table e7 Randomized controlled trials (RCTs) of surveillance follow-up programs after colorectal cancer (CRC) surgery.
Table e8 Guidelines on surveillance colonoscopy after curative intent resection of colorectal cancer (CRC).