Surveillance Pathways
There are 2 main pathways, depending on 1) histology and 2) macroscopic morphology
Histological Risk Stratification Pathway
High-risk histological findings:
- ≥2 pre-malignant polyps
Pre-malignant polyps include:
- Adenomas
- Some serrated polyps (saw-tooth appearance of colonic crypts)
Advanced polyp features:
-
Size ≥10 mm
-
Dysplasia
- ≥5 pre-malignant polyps
Pre-malignant polyps include:
- Adenomas
- Some serrated polyps (saw-tooth appearance of colonic crypts)
The surveillance pathway depends on whether there are high-risk findings or not:
| High-risk finding(s) present → | One-off surveillance colonoscopy at 3 years (with further surveillance guided by colonoscopic findings) |
| NO high-risk findings → | Return to national bowel cancer screening programme (no additional colonoscopic surveillance) |
Morphology-Based Pathway (LNPCPs)
This pathway only applies to LNPCPs: large (≥20mm), non-pedunculated colorectal polyps. All other polyps should follow the histology-based surveillance pathway (see above).
The surveillance pathway depends on resection and excision status:
| Complete (r0) resection Complete resection is defined as R0 (on histology):
En bloc excision: the polyp is removed in a single piece, not fragmented or piecemeal → |
One-off surveillance colonoscopy at 3 years (with further surveillance guided by colonoscopic findings) |
| Otherwise → | More intense surveillance colonoscopy is necessary:
|
Key takeaway: large (≥20mm), non-pedunculated colorectal polyps are associated with a higher risk of incomplete resection and local recurrence.
When Surveillance is Not Recommended
Do not offer routine surveillance if:
- Life expectancy <10 years
- Significant comorbidity
- Very advanced age (e.g. >75 years) (individualised decision)