| Theme |
Surveillance after Treatment for Colorectal Tumors |
| Title |
Post Colorectal Polypectomy Surveillance |
| Author |
Nozomu Kobayashi |
Department of Gastroenterology, Tochigi Cancer Center |
| Author |
Takahisa Matsuda |
Cancer Screening Center / Endoscopy Division, National Cancer Center Hospital |
| Author |
Yasushi Sano |
Gastrointestinal Center, Sano Hospital |
| Author |
Takahiro Fujii |
TF Clinic |
| [ Summary ] |
Guidelines for colonoscopic surveillance after colorectal polypectomy are well established in the Western countries, according to some large-scale studies including the National Polyp Study. Surveillance intervals are determined based on initial colonoscopic findings. The number, size and advanced histology of detected polyps are considered risk predicting factors for colon polyps observed during surveillance. On the other hand, there are no established guidelines or recommendations for surveillance after polypectomy in Japan. Surveillance colonoscopy is often recommended for patients more frequently according to individual physician's decisions. In 2000, the Japan Polyp Study (JPS) Workgroup was established to provide evidence-based guidelines for such patients. A multicenter randomized control trial conducted at 11 participating centers was initiated in 2003. Of 3,926 patients who consented to participate in the JPS inquiry, 2,166 patients completed duble baseline colonoscopies with removal of all adenomatous polyps and were randomly assigned to have follow-up colonoscopies at 1 and 3 years (two-exam group) or at 3 years only (one-exam group). The incidence of advanced histology (defined as index lesions) was significantly similar in individual groups as a result of non-inferiority tests 1.7 % in the two-exam group and 2.1 % in one-exam group, P= 0.017. An interval of at least three years after polypectomy has also been proven to be effective in Japan. The JPS will provide important evidence to establish Japanese guidelines in the near future. |