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Appropriateness of colonoscopy in Europe (EPAGE II) : surveillance after polypectomy and after resection of colorectal cancer

Arditi, C. and Gonvers, J.-J. and Burnand, B. and Minoli, G. and Oertli, D. and Lacaine, F. and Dubois, R. W. and Vader, J.-P. and Schusselé Filliettaz, S. and Peytremann-Bridevaux, I. and Pittet, V. and Juillerat, P. and Froehlich, F.. (2009) Appropriateness of colonoscopy in Europe (EPAGE II) : surveillance after polypectomy and after resection of colorectal cancer. Endoscopy, Vol. 41, H. 3. pp. 209-217.

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Official URL: http://edoc.unibas.ch/dok/A6007671

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Abstract

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for surveillance after polypectomy and after curative-intent resection of colorectal cancer (CRC), and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of surveillance colonoscopy after polypectomy and after resection of CRC was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: Most CRCs arise from adenomatous polyps. The characteristics of removed polyps, especially the distinction between low-risk adenomas (1 or 2, small [> 1 cm], tubular, no high-grade dysplasia) vs. high-risk adenomas (large [< or = 1 cm], multiple [< 3], high-grade dysplasia or villous features), have an impact on advanced adenoma recurrence. Most guidelines recommend a 3-year follow-up colonoscopy for high-risk adenomas and a 5-year colonoscopy for low-risk adenomas. Despite the lack of evidence to support or refute any survival benefit for follow-up colonoscopy after curative-intent CRC resection, surveillance colonoscopy is recommended by most guidelines. The timing of the first surveillance colonoscopy differs. The expert panel considered that 56 % of the clinical indications for colonoscopy for surveillance after polypectomy were appropriate. For surveillance after CRC resection, it considered colonoscopy appropriate 1 year after resection. CONCLUSIONS: Colonoscopy is recommended as a first-choice procedure for surveillance after polypectomy by all published guidelines and by the EPAGE II criteria. Despite the limitations of the published studies, colonoscopy is also recommended by most of the guidelines and by EPAGE II criteria for surveillance after curative-intent CRC resection.
Faculties and Departments:03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Innere Organe > Allgemein- und Viszeralchirurgie (Oertli)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Innere Organe > Allgemein- und Viszeralchirurgie (Oertli)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Gastroenterologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Gastroenterologie
UniBasel Contributors:Oertli, Daniel and Froehlich, Florian
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Bibsysno:Link to catalogue
Publisher:Georg Thieme
ISSN:0013-726X
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:18 Jul 2014 09:10
Deposited On:18 Jul 2014 09:10

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