New guidelines for surveillance colonoscopy

Many colonoscopies may be unnecessary, making it important that health practitioners follow new guidelines issued by Cancer Council Australia.

The new revised ‘Clinical Practice Guidelines for Surveillance Colonoscopy’ provide guidance on when and how colonoscopy should be used for Australians who have been diagnosed with a previous (adenomatous) polyp or bowel cancer, or who have ulcerative colitis or Crohn’s disease.

Dr Cameron Bell, Chair, Surveillance Colonoscopy Guidelines Working Party, Cancer Council Australia, said as well as summarising the latest evidence, the guidelines highlight the need for doctors to take more care when determining which patients should be referred for the procedure.

“Colonoscopy is an invasive procedure so should only be recommended when necessary and at the right intervals. Yet we know that Australia is currently performing almost one million colonoscopies a year — many of which may be unnecessary.”

“One of the ways we can better prioritise the use of colonoscopy services is to make sure everyone is following the guidelines for when and how often surveillance colonoscopy is used.”

Dr Bell said that some of the new recommendations related to using the latest colonoscopy technology.

“Everyone performing colonoscopies should familiarise themselves with the latest advances and recommendations in the new guidelines to make sure they are following the latest evidence. Specialists should also particularly familiarise themselves with the recommendations for frequency of colonoscopy after a bowel resection or discovery of low-risk polyps — these are two key areas where we suspect practice particularly varies from the guidelines.

“The new guidelines also offer clearer guidance about people whose polyps are sessile serrated adenomas than previously guidelines published in 2011.”

Key topics covered in the new guidelines include:

• the latest colonoscopy techniques, technologies and advances;
• when to repeat colonoscopy after removal of adenomatous polyps;
• when to repeat colonoscopy after curative resection for bowel cancer;
• when to perform colonoscopy in those patients with inflammatory bowel disease (IBD) who have an increased risk of developing bowel cancer.
   

Dr Bell said the new guidelines complement the ‘Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer’ released in 2017, which support Australia’s National Bowel Cancer Screening Program.

“Australia has a successful National Bowel Cancer Screening Program using iFOBT which is designed for Australians aged 50–74 who are at average risk of bowel cancer and aren’t displaying any symptoms.

“The latest guidelines are designed to complement this life-saving program by providing guidance on the use of repeat colonoscopy after a polyp or cancer is found. It also provides recommendations when low-risk patients can re-enter the National Bowel Cancer Screening Program.

“By targeting surveillance colonoscopy at those patients where it is actually needed and performing the procedure at the right intervals, we can ensure a timely service for those who need it most and reduce overall healthcare costs.”

The guidelines were commissioned by the federal Department of Health and endorsed by the National Health and Medical Research Council, and have been published on Cancer Council Australia’s Wiki at wiki.cancer.org.au.

Image credit: ©stock.adobe.com/au/Lisa F. Young