Recommendations updated for postcolonoscopy management

(HealthDay)—In two guideline updates from the U.S. Multi-Society Task Force on Colorectal Cancer, published in the March issue of Gastroenterology, recommendations are presented for postcolonoscopy management and endoscopic removal of colorectal lesions.

Samir Gupta, M.D., from the Veterans Affairs San Diego Healthcare System, and colleagues developed recommendations for postcolonoscopy management. The authors note that for patients with normal, high-quality colonoscopy, screening should be repeated in 10 years. After removal of one to two tubular adenomas <10 mm in size, seven- to 10-year follow-up is recommended. High-quality baseline examination is important. After removal of three to four adenomas <10 mm in size, colonoscopy should be repeated in three to five years. After removal of five to 10 adenomas <10 mm, colonoscopy should be repeated in three years. After removal of >10 adenomas, follow-up colonoscopy at one year rather than the general recommendation of less than three years is recommended.

Tonya Kaltenbach, M.D., from the University of California-San Francisco, and colleagues developed recommendations to optimize complete and safe endoscopic removal techniques for colorectal lesions. The authors recommend cold snare polypectomy for diminutive and small lesions due to high complete resection rates and safety profile; cold forceps polypectomy is not recommended for diminutive lesions. Hot biopsy forceps are not recommended for diminutive and small lesions due to high incomplete resection rates. Cold or hot snare polypectomy is recommended for nonpedunculated (10 to 19 mm) lesions. Endoscopic mucosal resection is recommended as the preferred treatment method of large nonpedunculated colorectal lesions.

“Endoscopic resection of precancerous lesions reduces the incidence of CRC,” Kaltenbach and colleagues write. “Ineffective resection results in residual neoplasia and appears to be the cause of some interval cancers.”

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