Post-Polypectomy Colonoscopy Surveillance

Surveillance is becoming common in the practice of colonoscopy because a large number of patients with colorectal polyps are now being discovered as a result of the increased use of colorectal cancer screening, and particularly because of the dramatic increase in screening colonoscopy. Although the term ‘colorectal polyp’ is not synonymous with colorectal adenoma, two-thirds of colorectal polyps are adenomas and most colorectal cancers arise from them. Therefore, removal of colorectal polyps using colonoscopic polypectomy has been shown to reduce the risk of future colorectal cancer (Winawer et al., 1993; Atkin et al., 2010). A patient with one colorectal adenoma has a 30 to 50% likelihood of harboring a second synchronous adenoma elsewhere in the colon and rectum at that time, and they have a 3050% likelihood of developing metachronous adenoma sometime in the future (Winawer et al., 2006; Arditi et al., 2009). Therefore, to minimize the risk for colorectal cancer in the future, patients with adenomas are usually placed into a post-polypectomy surveillance program. Post-polypectomy surveillance refers to periodically examining the colon to detect and remove missed synchronous and new metachronous adenomas and cancers, by screening or other means, after the detection and removal of a precancerous lesion. Generally, it does not refer to the use of colonoscopy or other procedures to monitor for polyp or cancer recurrence following a diagnosis of colorectal cancer. This chapter reviews the rationale, the recent literature and the current recommendations for post-polypectomy surveillance, with emphasizing the need to tailor surveillance strategies to the carefully considered individualized assessment of the risk factors as related to the characteristics of the baseline adenoma and those of the individual patient.