French Society of Digestive Endoscopy (SFED) Guideline

The clinical practice guidelines on the indications for colonoscopy in the diagnosis of neoplasia, published in 1996 by the French National Agency for Accreditation and Evaluation in Healthcare (ANAES, recently renamed “Haute Autorité de Santé” or HAS) [1], were updated in 2004. These guidelines were produced using the three-step method employed by ANAES-HAS: (i) a critical appraisal of the literature, (ii) three meetings of a multidisciplinary working group, and (iii) comments on the draft guidelines obtained from 45 peer reviewers. The guidelines are available in both French and English on the HAS website (www.has.fr) [2]. The report outlining the supportive arguments on which the guidelines are based is available in French only. The guidelines are summarized here in [Table 1].

Table 1 Surveillance schedules and methods for each indication for lower gastrointestinal endoscopy Indication Age for starting surveillance, years Surveillance schedule Method used Surveillance of asymptomatic people at very high risk of colorectal cancer Relatives of a patient with FAP 10 - 12 Every year Flexible proctosigmoidoscopy People with FAP, after colectomy - surveillance of remaining rectum - Every year Flexible proctosigmoidoscopy Relatives of a patient with attenuated FAP 30 Every year Complete colonoscopy Polyposis of the colon with MHY mutation 30 No recommendation Complete colonoscopy Relatives of a patient with HNPCC 20 - 25 Every 2 years Complete colonoscopy People with HNPCC, after colon surgery - Every 2 years Complete colonoscopy Juvenile polyposis: patients with the condition and relatives of an affected patient 10 - 15 Every 2 - 3 years Complete colonoscopy Peutz-Jeghers syndrome: patients with the condition and relatives of an affected patient 18 Every 2 - 3 years Complete colonoscopy Surveillance of asymptomatic people at high risk of colorectal cancer Family history of colorectal cancer: in one first-degree relative before the age of 60; or in several first-degree relatives irrespective of age 45, or 5 years before the age of the index case diagnosis Surveillance at 5 years, then (if the colonoscopy is normal) two colonoscopies 5 years apart, then (if the colonoscopy is normal) extend intervals between exams Complete colonoscopy Family history of colorectal cancer in a first-degree relative and discovery of non-advanced adenoma - Surveillance colonoscopy at 3 years Complete colonoscopy Family history of colonic adenoma in a first-degree relative before the age of 60 45, or 5 years before the age of the index case diagnosis Depends on the result of the first colonoscopy Complete colonoscopy Personal history of colorectal cancer if preoperative colonoscopy was incomplete - Surveillance at 6 months, then (if the colonoscopy is normal) at 2 - 3 years, then at 5 years Complete colonoscopy Personal history of colorectal cancer if preoperative colonoscopy was complete - Surveillance at 2-3 years, then (if the colonoscopy is normal) at 5 years Complete colonoscopy Patient with acromegaly At diagnosis of acromegaly Depends on the result of the first colonoscopy Complete colonoscopy Surveillance of asymptomatic people at high risk of colorectal cancer, after resection of colorectal polyps Hyperplastic polyps: After resection of one hyperplastic polyp ≥ 1 cm and/or multiple polyps (n ≥ 5) in the colon and/or in the proximal colon if there is a family history of hyperplastic polyps - Surveillance at 5 years, then (if the colonoscopy is normal) at 10 years Complete colonoscopy Adenoma at the low-grade dysplasia stage and advanced adenomas*: Incomplete resection of an adenoma at the low-grade dysplasia stage (category 3); or advanced adenoma (categories 4.1 and 4.2) - Surveillance at 3 months Complete colonoscopy Complete resection of an advanced adenoma, or of multiple adenomas (n ≥ 3); or of an adenoma in a patient with a family history of colorectal cancer - Surveillance at 3 years (if the colonoscopy is normal), then two colonoscopies 5 years apart, then at 10 years Complete colonoscopy Complete resection of a nonadvanced adenoma and multiple adenomas (n < 3) and no family history of colorectal cancer - Surveillance at 5 years, then (if the colonoscopy is normal) colonoscopy at 5 years, then (if the colonoscopy is normal) at 10 years Complete colonoscopy Transformed adenoma: Incomplete resection of a category 4 transformed adenoma - Surveillance at 3 months, then (if the colonoscopy is normal) at 3 years Complete colonoscopy Complete resection of a category 4 transformed adenoma - Surveillance at 3 years Complete colonoscopy Resection of a category 5 transformed adenoma without additional colectomy - Surveillance at 3 months, then (if the colonoscopy is normal) at 3 years Complete colonoscopy FAP, familial adenomatous polyposis; HNPCC, hereditary nonpolyposis colorectal cancer.* Advanced adenoma, size ≥ 1 cm, or if it contains > 25 % villous tissue, or in cases of high-grade dysplasia or carcinoma in situ (Vienna classification categories 4.1 or 4.2).

These guidelines do not concern mass screening but address the role of colonoscopy in diagnosing neoplasia in people who are at high risk or very high risk of colorectal cancer and in people at average risk of colorectal cancer in special clinical situations. The guidelines also provide recommendations for the surveillance of asymptomatic individuals at high or very high risk of colorectal cancer.

References

• 1 Agence Nationale pour le Developpement de l’Evaluation Medicale . Lower digestive endoscopies: recommendations and medical references [in French].  Gastroenterol Clin Biol. 1996;  20 881-896
• 2 French National Agency for Accreditation and Evaluation in Healthcare .Clinical practice guidelines: indications for lower gastrointestinal endoscopy (excluding population screening). 2004. Available at: URL: http://www.has-sante.fr/portail/upload/docs/application/pdf/Endoscopy_guidelines.pdf