Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
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DOI：
10.1055/s-0033-1344548
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发表时间：
2013-10-01
期刊：
影响因子：
9.3
通讯作者：
Lieberman, David
中科院分区：
文献类型：
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作者：
Hassan, Cesare;Quintero, Enrique;Lieberman, David
该指南是欧洲胃肠内窥镜学会(ESGE)的一份官方声明。采用建议评估、发展和评价分级(等级)制度来确定建议的强度和证据的质量。主要建议：只有在高质量的基线结肠镜检查完全切除所有发现的肿瘤性病变后，才应应用以下建议进行息肉切除术后的内窥镜监测。1在低风险组(有1-2个管状腺瘤和10 mm低级别异型增生的患者)，ESGE建议在指数结肠镜检查10年后参加现有的国家筛查计划。如果没有可用的筛查方案，建议在指标结肠镜检查后10年重复进行结肠镜检查(强烈建议，中等质量的证据)。2在高危组(腺瘤有绒毛组织学或高度不典型增生或10 mm大小，或腺瘤3例)，ESGE建议在指标结肠镜检查后3年进行监视结肠镜检查(强烈建议，中等质量证据)。有10个或10个以上腺瘤的患者应接受遗传咨询(强烈建议，中等质量的证据)。3在高危组，如果在第一次监测检查中没有发现高危腺瘤，ESGE建议在第二次监测结肠镜检查之前间隔5年(建议较弱，证据质量较低)。如果在第一次或随后的监测检查中发现高风险腺瘤，建议重复3年的监测结肠镜检查(强烈建议，低质量证据)。4 ESGE建议，锯齿状息肉大于或等于10毫米且无不典型增生的患者应被归类为低风险患者(建议较弱，证据质量较低)。ESGE建议，患有巨大锯齿状息肉(10毫米)或发育不良的患者应被归类为高危患者(建议较弱，证据质量较低)。5 ESGE建议内窥镜医生负责为息肉切除术后的监测时间表提供书面建议(强烈建议，证据质量低)。
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations: The following recommendations for post-polypectomy endoscopic surveillance should be applied only after a high quality baseline colonoscopy with complete removal of all detected neoplastic lesions. 1 In the low risk group (patients with 1 - 2 tubular adenomas < 10 mm with low grade dysplasia), the ESGE recommends participation in existing national screening programmes 10 years after the index colonoscopy. If no screening programme is available, repetition of colonoscopy 10 years after the index colonoscopy is recommended (strong recommendation, moderate quality evidence). 2 In the high risk group (patients with adenomas with villous histology or high grade dysplasia or 10 mm in size, or 3 adenomas), the ESGE recommends surveillance colonoscopy 3 years after the index colonoscopy (strong recommendation, moderate quality evidence). Patients with 10 or more adenomas should be referred for genetic counselling (strong recommendation, moderate quality evidence). 3 In the high risk group, if no high risk adenomas are detected at the first surveillance examination, the ESGE suggests a 5-year interval before a second surveillance colonoscopy (weak recommendation, low quality evidence). If high risk adenomas are detected at first or subsequent surveillance examinations, a 3-year repetition of surveillance colonoscopy is recommended (strong recommendation, low quality evidence). 4 The ESGE recommends that patients with serrated polyps < 10 mm in size with no dysplasia should be classified as low risk (weak recommendation, low quality evidence). The ESGE suggests that patients with large serrated polyps ( 10 mm) or those with dysplasia should be classified as high risk (weak recommendation, low quality evidence). 5 The ESGE recommends that the endoscopist is responsible for providing a written recommendation for the post-polypectomy surveillance schedule (strong recommendation, low quality evidence).