Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2016; 22(6): 1925-1934
Published online Feb 14, 2016. doi: 10.3748/wjg.v22.i6.1925
Surveillance of colonic polyps: Are we getting it right?
Stewart N Bonnington, Matthew D Rutter
Stewart N Bonnington, Matthew D Rutter, Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees TS19 8PE, United Kingdom
Stewart N Bonnington, Matthew D Rutter, Durham University, Stockton-on-Tees TS17 6BH, United Kingdom
Author contributions: Bonnington SN performed the literature review and wrote the manuscript; and Rutter MD reviewed and amended the manuscript and advised on content.
Conflict-of-interest statement: Stewart N Bonnington and Matthew D Rutter declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Stewart N Bonnington, Department of Gastroenterology, University Hospital of North Tees, Hardwick Road, Stockton-on-Tees TS19 8PE, United Kingdom. snbonnington@doctors.org.uk
Telephone: +44-1642-624557 Fax: +44-1642-383289
Received: July 27, 2015
Peer-review started: July 30, 2015
First decision: August 31, 2015
Revised: October 15, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: February 14, 2016
Processing time: 179 Days and 21.8 Hours
Abstract

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. The identification of colonic polyps can reduce CRC mortality through earlier diagnosis of cancers and the removal of polyps: the precursor lesion of CRC. Following the finding and removal of colonic polyps at an initial colonoscopy, some patients are at an increased risk of developing CRC in the future. This is the rationale for post-polypectomy surveillance colonoscopy. However, not all individuals found to have colonic adenomas have a risk of CRC higher than that of the general population. This review examines the literature on post-polypectomy surveillance including current international clinical guidelines. The potential benefits of surveillance procedures must be weighed against the burden of colonoscopy: resource use, the potential for patient discomfort, and the risk of complications. Therefore surveillance colonoscopy is best utilised in a selected group of individuals at a high risk of developing cancer. Further study is needed into the specific factors conferring higher risk as well as the efficacy of surveillance in mitigating this risk. Such evidence will better inform clinicians and patients of the relative benefits of colonoscopic surveillance for the individual. In addition, the decision to continue with surveillance must be informed by the changing profile of risks and benefits of further procedures with the patient’s advancing age.

Keywords: Adenoma; Polyp; Colonoscopy; Surveillance; Colorectal cancer

Core tip: Increasing numbers of surveillance colonoscopies for previous colonic polyps are being performed. Each colonoscopy brings the burden of bowel preparation, potential discomfort, and risk of complications. Colonoscopy is a finite resource and must be recommended only with a strong indication. Individuals with non-advanced adenomas have no significantly increased risk of colorectal cancer (CRC) compared to the general population. Patients with an advanced adenoma, have a CRC risk similar to that of the general population after just one surveillance colonoscopy. This review examines the evidence behind current surveillance guidelines and questions the rationale for surveillance in individuals with relatively low cancer risk.