Post-Polypectomy Surveillance
British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines.
Surveillance Pathways
There are 2 main pathways, depending on 1) histology and 2) macroscopic morphology
Histological Risk Stratification Pathway
High-risk histological findings:
- ≥2 pre-malignant polyps with ≥1 advanced polyp, or
- ≥5 pre-malignant polyps
The surveillance pathway depends on whether there are high-risk findings or not:
| High-risk finding(s) present → | One-off surveillance colonoscopy at 3 years (with further surveillance guided by colonoscopic findings) |
| NO high-risk findings → | Return to national bowel cancer screening programme (no additional colonoscopic surveillance) |
Morphology-Based Pathway (LNPCPs)
This pathway only applies to LNPCPs: large (≥20mm), non-pedunculated colorectal polyps. All other polyps should follow the histology-based surveillance pathway (see above).
The surveillance pathway depends on resection and excision status:
| Complete (r0) resection + en bloc excision → | One-off surveillance colonoscopy at 3 years (with further surveillance guided by colonoscopic findings) |
| Otherwise → | More intense surveillance colonoscopy is necessary:
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Key takeaway: large (≥20mm), non-pedunculated colorectal polyps are associated with a higher risk of incomplete resection and local recurrence.
When Surveillance is Not Recommended
Do not offer routine surveillance if:
- Life expectancy <10 years
- Significant comorbidity
- Very advanced age (e.g. >75 years) (individualised decision)