Guidelines for polyp screening

1. 205
Rutter MD, et al. Gut 2020;69:201–223. doi:10.1136/gutjnl-2019-319858
Guidelines
Figure 1 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE)
post-
­
polypectomy and post-
­
colorectal cancer resection surveillance guideline algorithm. LNPCP, large non-
­
pedunculated colorectal polyp; NPCPs, non-
­
pedunculated colorectal polyps; y, years.
involved in the decision-­
making process and improved safety and
better clinical outcomes. However, there is a paucity of evidence
regarding patient views on, and experiences of, surveillance. This
is consistent with the lack of research regarding patient views and
experiences of endoscopy, and is an area that requires significant
research.27 28
Patients should have the evidence for surveillance explained
to them and risks and benefits of different strategies explained.
The principles of shared decision-­
making and informed choice
should be applied. Patients should also be made aware of any
alternative strategy available, and a discussion should take place
regarding risks and benefits. Patient needs and expectations
should be kept in mind and addressed where possible.
Patients should be made aware of other evidence-­
based interven-
tions that could reduce their risk of CRC and/or polyp recurrence.
These could include lifestyle and behavioural modifications (eg,
stopping smoking and reducing red meat consumption) as well as
medications (eg, aspirin).
Information should be conveyed in a manner and language that
is understandable, allowing patients to make informed choices.
Information should be provided in clear written form and with
clear verbal explanation and opportunity for reflection and discus-
sion. Patients should be made aware of whom they can contact in
the event of any subsequent questions about surveillance.
Surveillance guidelines recommendations
The following recommendations have been developed by the
GDG, based on the predetermined surveillance principles, the
underlying evidence and following detailed discussion and
consensus voting. These recommendation are summarised in
figure 1.
We recommend that the high-­
risk criteria for future CRC
comprise either:
►
► two or more premalignant polyps including at least one
advanced colorectal polyp (defined as a serrated polyp of
at least 10mm in size or containing any grade of dysplasia,
or an adenoma of at least 10mm in size or containing high-­
grade dysplasia); or
►
► five or more premalignant polyps.
GRADE of evidence: See later evidence section
Strength of recommendation: Strong
The guidelines incorporate surveillance of patients following
resection of either adenomatous or serrated polyps, aiming
to simplify risk stratification of patients who may have both
types of polyp. Surveillance following resection of CRC and
LNPCPs have also been incorporated into the same algorithm
in order to standardise surveillance across these broad cohorts
of patients.
on
January
24,
2020
by
guest.
Protected
by
copyright.
http://gut.bmj.com/
Gut:
first
published
as
10.1136/gutjnl-2019-319858
on
27
November
2019.
Downloaded
from