Korean guidelines for postpolypectomy colonoscopy surveillance

Abstract

Postpolypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. In this report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy and we elucidated the high risk findings of the index colonoscopy as follows: 3 or more adenomas, any adenoma larger than 10 mm, any tubulovillous or villous adenoma, any adenoma with high-grade dysplasia, and any serrated polyps larger than 10 mm. Surveillance colonoscopy should be performed five years after the index colonoscopy for those without any high-risk findings and three years after the index colonoscopy for those with one or more high risk findings. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polypectomy, the patient's general condition, and family and medical history.

Keywords: Colonoscopy; Colorectal neoplasms; Guideline; Polypectomy; Surveillance.

Fig. 1

Flow chart outlining search process used to identify articles for inclusion in systematic review and meta-analysis.

Fig. 2

Forest plot for the number of colorectal adenomas as a risk factor for advanced neoplasia. CI, confidence interval.

Fig. 3

Forest plot for the size of colorectal adenomas as a risk factor for advanced neoplasia. CI, confidence interval.

Fig. 4

Forest plot for villous/tubulovillous adenomas as a risk factor for advanced neoplasia. CI, confidence interval, TA, tubular adenoma.

Fig. 5

Forest plot for adenomas with high grade dysplasia as a risk factor for advanced neoplasia. CI, confidence interval.

Fig. 6

Forest plot of the large (≥10 mm) serrated polyps at index colonoscopy as a risk factor for advanced neoplasia. CI, confidence interval.

Fig. 7

Forest plot for the location of index polyps as a risk factor for advanced neoplasia. CI, confidence interval.

Fig. 8

Forest plot for the gender as a risk factor for advanced neoplasia. CI, confidence interval.

Fig. 9

Forest plot for the family history of colorectal cancers as a risk factor for advanced neoplasia. CI, confidence interval.