Recommendations for surveillance of adenomas

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Published: 5 Jul 2017
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Prof Jaroslaw Regula - Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland

Prof Regula talks with ecancer at ESMO GI 2017 about the recommendations for surveillance after surgery to remove adenomas. He goes on to discuss the differences in recommendations and guidelines depending on geographic location. 

Prof Regula then discusses the need to assess all recommendations coming out of trails in order to get the best care possible for patients.

My presentation here is recommendations for the surveillance after removal of colorectal polyps, adenomas. The main aspect of my talk is to say that we have several different recommendations concerning this issue and American, European, Asian and other societies provide different recommendations based on different intervals between the removal of adenoma and the next control endoscopy. As well there are differences in the definition of risk groups, low risk and high risk, there is also one UK recommendation having an intermediate risk patient.

The guidelines are based on studies where the endpoint was advanced adenomas mainly and not the risk of colorectal cancer or death from colorectal cancer. So these data are not based on rocket hard data and, in fact, are based on expert recommendations. So there is a need for better data, for the randomised controlled trials assessing different types of recommendations to get, in the end, final uniform global recommendations after adenoma removal and to have this data based on the randomised trials with the endpoints, hard endpoints like colorectal cancer incidence and mortality. So this is the main topic of my talk.

Of course I will present as well the current recommendations that should be used in different areas of the world and what are the conditions to be used. The main condition of the proper usage of these recommendations is the high quality colonoscopy performed as the initial recommendation. High quality endoscopy means perfect bowel preparation, visualisation of the whole large bowel, not only the part, and the endoscopist has to be a high quality doctor. We have now the measure of the high quality doctor, this is the adenoma detection rate that can be attributed to each individual doctor and also to each individual endoscopy clinic in the world. So the high quality procedure is the procedure performed by persons that have this high quality indicator.

As you see, there are a lot of problems with these surveillance guidelines. Firstly, the basis of these guidelines are weak, we need to have better results of the studies to improve these guidelines in the future.