Comparison of recommendations for surveillance of advanced colorectal polyps - a systematic review of guidelines.

AIM: Patients diagnosed with advanced colorectal lesions have a higher risk of developing colorectal cancer. International polyp surveillance guidelines have recently been updated. The aim of this systematic review was to assess surveillance recommendations for advanced colorectal polyps and compare the patient, polyp and colonoscopy quality factors considered in their recommendations.

METHOD: Guidelines with surveillance recommendations for colorectal polyps were identified. Databases searched included PubMed, Web of Science, Scopus and Trip Pro and guidelines identified by two blinded reviewers. The review protocol was registered on PROSPERO and performed in line with PRISMA guidelines.

RESULTS: Six guidelines from the US Multi-Society Task Force, British Society of Gastroenterology, Cancer Council Australia, European Society of Gastrointestinal Endoscopy, Japan Gastroenterological Endoscopy Society and Asia-Pacific Working Group on Colorectal Cancer Screening were included. The recommended surveillance interval of 3 years was consistent, but the criteria used for advanced polyps was variable. Polyp factors were the key determinant for when surveillance should be performed. Although all guidelines recognised their importance, the application of and evidence underlying patient characteristics and the quality of baseline colonoscopy was limited. All included guidelines were rated of average to high quality by the AGREE II instrument.

CONCLUSION: Surveillance guidelines for advanced colorectal polyps are of good quality but limited by their underlying evidence. Standardisation of definitions would be valuable for both research and clinical application. Better knowledge of colonoscopist quality indicators and patient factors is recommended to further economise surveillance recommendations, minimise patient risk and achieve optimal outcomes without increasing pressure on services.