Colonoscopy Guidelines After Polyp Removal Don't Predict Later Polyp Development

According to an article in the March 18 issue of the Annalsof Internal Medicine, current guidelines call for follow-up colonoscopy after polyp removal based on the number, type, and size of polyps removed. For example, after removal of a polyp that is about one centimeter in size or three polyps of any size, guidelines recommend that patients have follow-up colonoscopy in three years, while those with smaller and/or fewer polyps are recommended to get a follow-up colonoscopy in five to 10 years.

An analysis of 1,905 people who had colorectal polyps removed found that this risk stratification scheme did not predict development of advanced polyps, which are considered most likely to advance to colorectal cancer.

The researchers note that colonoscopy already constitutes about 34 percent of procedures performed in the United States, and overuse can affect scarce health resources.

Editorial writers say the issue of follow-up colonoscopy is complicated by the fact that little is known about the natural history of the large polyp to understand which ones grow into cancer; that future guidelines should consider clinical factors such as cigarette smoking, waist circumference and insulin resistance in determining high risk screening categories; and finally, that for some patients, even a small 5 percent risk for developing advanced polyps is too high not to have early and frequent follow-up colonoscopies.

Source: American College of Physicians

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