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Colon Polyp Follow Up Guidelines

by Etienne Moore last modified 2012-04-28 18:19

Click here to see Mr Moore's clinic guidelines for the follow up of patients with polyps found at colonoscopy

Hyperplastic or Metaplastic Polyps

No colonoscopic follow up currently recommended

Benign Adenomatous Polyps

High Risk - (5 or more adenomas smaller than 10mm) or (3 or more adenomas if one is 10mm or larger)

Check colonsocopy again in 1 year if patient fit and willing

If subsequent colonsocopy is negative for adenomas, low risk or intermediate risk then follow intermediate risk guidelines (next colonoscopy in 3 years).

If subsequent colonoscopy is incomplete then consider computed tomographic colonography (also known as CTC or CT cologram) instead or offer a repeat colonoscopy with a more experienced colonoscopist.  The risks and benefits should be discussed with the patient (and their family and carers if appropriate) and the patient's decision (or patient's advocate decision for patient's who cannot consent) documented.

Intermediate Risk - (3 or 4 adenomas smaller than 10mm) or (1 or 2 adenomas if one is 10mm or larger)

Check colonoscopy again in 3 years if patient fit and willing

If subsequent colonoscopy is negative for adenomas then repeat colonoscopy in 3 years again.  Stop colonoscopic surveillance if there is a further negative result.

If subsequent colonoscopy is low or intermediate risk then follow up as for intermediate risk (next colonoscopy in 3 years).

If subsequent colonoscopy is high risk then follow up as for high risk (next colonoscopy in 1 year).

If subsequent colonoscopy is incomplete then consider computed tomographic colonography (also known as CTC or CT cologram) instead or offer a repeat colonoscopy with a more experienced colonoscopist.  The risks and benefits should be discussed with the patient (and their family and carers if appropriate) and the patient's decision (or patient's advocate decision for patient's who cannot consent) documented.

Low Risk - 1 to 2 adenomas smaller than 10mm

Check colonoscopy again in 5 years if patient fit and willing

If subsequent colonoscopy is negative for adenomas then cease follow up.

If subsequent colonoscopy is low risk then follow up as for low risk (repeat colonoscopy in 5 years if patient fit and willing).

If subsequent colonoscopy is intermediate risk follow up as for intermediate risk (repeat colonoscopy in 3 years).

If subsequent colonoscopy is high risk follow up as for high risk (repeat colonoscopy in 1 year).

If subsequent colonoscopy is incomplete then consider computed tomographic colonography (also known as CTC or CT cologram) instead or offer a repeat colonoscopy with a more experienced colonoscopist.  The risks and benefits should be discussed with the patient (and their family and carers if appropriate) and the patient's decision (or patient's advocate decision for patient's who cannot consent) documented.

High Grade Dysplasia or Carcinomatous Polyps

Urgently refer the patient to the BSUH colorectal cancer MDT (multi-disciplinary team) coordinator on the telephone via switchboard or via Trust e-mail so that the patient can be discussed at the next weekly colorectal cancer MDT meeting.  Tell the patient that a member of the colorectal team will contact them after the colorectal MDT meeting with the next step and please clearly document in the patient hospital notes what you have told the patient and whether you have already requested any staging scans or blood tests.

Ideally discuss the patient with Mr Moore if possible.

Dictate an urgent clinic letter to GP and copy letter to colorectal cancer MDT coordinator and also copy to colorectal Macmillan nurses.

Patients with histologically confirmed colorectal adenocarcinoma should be referred for urgent staging CT contrast scan of chest, abdomen and pelvis.  Make sure that renal function blood tests have been arranged if these are necessary prior to contrast injection (mainly diabetic and renal failure patients).  Patients with rectal adenocarcinoma (usually within 15cm of the anal verge on endoscopy) should additionally be referred for urgent pelvic MRI scanning.

Also arrange for the patient to have a baseline CEA tumour marker blood test.

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