Luminary Learning Gastrointestinal Disorder- Issue 1

34  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS screening at age of 10–12 years with annual flexible sigmoidoscopy. In reality however, there is no nonsurgical, pharmacological, or endoscopic intervention that could obviate the necessity for a prophylactic surgical resection (typically proctocolectomy) which should be planned for an appropriate time between ages 16 and 25. Particularly with wide availability of genetic testing, it is therefore our recommendation that these patients wait with “screening” until they reach the age of 14, as those 2–4 additional years allow these young patient to mature and get an opportunity Table 3: Indications for screening based on risk constellation. Start Interval to subsequent colonoscopy (if no pathological findings) Average risk • No personal/family risk factors Age 50 years Every 10 years Increased risk • African-American ethnicity, Ashkenazi Jews, and other subgroups Age 45 years (5-) 10 • Personal history of CRC Clearing colonoscopy within 6 months of surgical resection 1/3/5 years • Personal history of large adenomatous polyp (>1 cm), multiple colorectal polyps of any size, or sessile serrated adenomas (proximal to sigmoid colon) – 1/3/5 years • Family history of CRC in FDR <60 years Age 40 years or 10 years before the youngest affected immediate family member Every 5 years • Family history of CRC in any 2 or more family member(s) age <60 years Age 40 years or 10 years before the youngest affected immediate family member Every 5 years • Family history of CRC in FDR(s) >60 years Age 50 years Every 10 years High risk • FAP Age 14 Annual with flexible sigmoidoscopy or colonoscopy until proctocolectomy @age 16–25 • FAP, status post IPAA/Kock pouch 1 year after surgery Annual pouchoscopy and monitoring of ATZ • Lynch syndrome/HNPCC Age 20–25 years, or 10 years before youngest affected family member Every 1–2 years • Chronic IBD (UC, Crohn) 7–8 years post onset Every 1–2 years • IBD, status post IPAA/Kock pouch 1 year after surgery Every 1–3 years FDR first-degree relative, ATZ anal transitional zone, FAP  familial adenomatous polyposis, UC ulcerative colitis,  IBD  inflammatory bowel disease,  IPAA  ileal pouch anal anastomosis, CRC colorectal cancer