Surveillance after Colorectal Polyps

Introduction: Both the American Gastroenterology Association and the British Society of Gastroenterology have issued guidelines that increase the interval between surveillance colonoscopies after the discovery of a polyp. If implemented this would greatly reduce the burden in endoscopy units. Our aim was through a retrospective audit of our polyps determine how often scopes were repeated, and could this be reduced safely.

Results: 1284 patients had polyps removed in our unit between 1998 and 2003. The age range was 24 to 93 years with a mean age of 62 years. There was a slight preponderance of males with 55% being male. 62% were tubular adenomas, 20% tubulovillous adenomas, 1% villous adenomas, 17% hyperplastic polyps, and 5% had high grade dysplasia. 61% were rectal, 16% sigmoid, 3% transverse colon, 1% ascending colon, and 19% in the caecum.

80% of patients had a repeat colonoscopy. Of those who had a repeat colonoscopy 61% had a normal scope. 30% had two normal colonoscopies within 2 years and 7% had three normal colonoscopies within 3 years. In the remainder the location of the polyps suggested recurrence was most likely rather than development of a new polyp.

Conclusion: The number of surveillance colonoscopies can be reduced. If the interval is increased then the quality of the colonoscopy becomes very important.