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The American College of Physicians (ACP) established its evidence-based clinical practice guidelines program in 1981. The ACP clinical practice guidelines and guidance statements follow a multistep development process that includes a systematic review of the evidence, deliberation of the evidence by the committee, summary recommendations, and evidence and recommendation grading.


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A 50-year-old man is seen to discuss the results of his recently performed initial screening colonoscopy. This study revealed a 7-mm flat polyp in the ascending colon that was removed entirely using cold biopsy forceps. Histology showed it to be a sessile serrated polyp without dysplasia. No other polyps were found during his screening colonoscopy. His medical history is unremarkable, and his family history is negative for colorectal cancer and inherited polyposis syndromes.

Physical examination is unremarkable.

Q.

Which of the following is the most appropriate recommended time period for this patient's next surveillance colonoscopy?

This patient should undergo surveillance colonoscopy 5 years after his initial screening colonoscopy. Sessile serrated polyps are typically flat and are found most commonly in the proximal colon. They can be difficult to detect during colonoscopy because they may have an overlying layer of adherent mucus. Sessile serrated polyps are believed to be the principal precursor lesions of hypermethylated malignancies that account for 20% to 30% of colorectal cancers. The United States Multi-Society Task Force on Colorectal Cancer published updated guidelines in 2012 for surveillance colonoscopy based on the histology and number of polyps detected during baseline screening. Although evidence is limited, these guidelines are the first to address surveillance of sessile serrated polyps found during the initial screening colonoscopy. The guidelines recommend that patients with sessile serrated polyps 10 mm or larger, or those with dysplasia, undergo surveillance colonoscopy 3 years after their initial screening examination, similar to high-risk adenomas. Patients such as this one with sessile serrated polyps smaller than 10 mm and without dysplasia should undergo surveillance colonoscopy in 5 years, similar to low-risk adenomas.

Patients with sessile serrated polyposis syndrome (at least 5 serrated polyps proximal to the sigmoid colon with two or more ≥10 mm, any serrated polyps proximal to the sigmoid colon with a family history of serrated polyposis syndrome, or >20 serrated polyps of any size throughout the colon) should undergo surveillance colonoscopy at a 1-year interval.

Because the sessile serrated polyp detected and removed during this patient's initial screening colonoscopy was not 10 mm in diameter or larger and did not contain dysplasia, performing a surveillance colonoscopy 3 years after the initial screening colonoscopy is not appropriate.

Patients with no polyps or hyperplastic polyps in the sigmoid colon and rectum should undergo surveillance colonoscopy 10 years after their baseline screening colonoscopy.

Key Point

  • Updated guidelines for surveillance colonoscopy from The United States Multi-Society Task Force on Colorectal Cancer are the first to address surveillance of sessile serrated polyps found during initial screening colonoscopy; the guidelines recommend that patients with sessile serrated polyps smaller than 10 mm and without dysplasia should undergo surveillance colonoscopy 5 years after their initial screening colonoscopy.
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