Luminary Learning Gastrointestinal Disorder- Issue 1

36  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS or whose colonoscopy was incomplete or otherwise unsatisfactory, an interval of a few months may have to be recommended (unless a surgical resection is carried out). No adjustment to the screening schedule of 10 years is needed if there were only hyperplastic polyps with typically distal distribution in the rectum and sigmoid colon. Patients with proximal serrated adenomata/polyps or with hyperplastic polyposis syndrome are exceptions from that. For patients undergoing a curative resection for a colorectal cancer or advanced polyps, there should be a full colonic evaluation to rule out synchronous lesions. If the circumstances did not allow for preoperative clearance of the entire colon (e.g., emergency, obstruction), a full examination should be recommended within 6 months of the surgery. Subsequently, patients with Table 4: Colonoscopy quality parameters. Accepted quality parameters Benchmark Withdrawal time (WT) ≥6 min Cecal intubation rate (with photo documentation) ≥95% Adenoma detection rate (ADR) in average risk screening colonoscopy ≥ 25% in men, ≥ 15% in women Alternate or unquantified parameters Detail Polyp detection rate (PDR), including nonadenomatous polyps (hyperplastic polyps) 35% Detection rate of proximal sessile serrated adenomata/polyps (SSA/SSP) >4.5% Miss rate <6–12% Quality of bowel cleansing Scored by various instruments: (e.g., Boston bowel prep scale 0–9, based on sum of assessments in 3 segments, 0=unprepped, 3=perfect) Incidence of interval cancer within 3–5 years <2–9% Table 5: Impact of pathological findings on subsequent surveillance intervals. Pertinent findings on index colonoscopy Interval to subsequent colonoscopy Small hyperplastic polyps in distal rectosigmoid 10 years 1–2 small tubular adenomas <1 cm with low-grade dysplasia 5–10 years 3–10 adenomas, or 1 adenoma >1 cm, or any adenoma with villous features/ high-grade dysplasia 3 years More than 10 adenomas completely removed in a single examination 1–2 years Sessile adenomata removed in piecemeal <6 months Polyps in Lynch syndrome 1–2 years