Contributing to Australia's surveillance colonoscopy guidelines

When a report says the next colonoscopy is due in three years rather than five or ten, that interval is not a matter of opinion. It comes from the Clinical Practice Guidelines for Surveillance Colonoscopy, developed by Cancer Council Australia, funded by the Australian Government Department of Health and approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 7 December 2018 under section 14A of the NHMRC Act. The short-form summary of the approved recommendations was last updated in March 2019.

A/Prof Kariyawasam was a member of the non-remunerated working party that produced them, contributing to the section on colonoscopic surveillance and the management of dysplasia in inflammatory bowel disease.

What the guidelines cover

• Surveillance intervals after polyps are removed, separated by what was found: low-risk adenomas, high risk adenomas, five or more adenomas, serrated polyps and large sessile or laterally spreading lesions.
• Whether family history should change the interval and what subsequent colonoscopies should look like.
• When surveillance should stop, which matters more as people get older and the balance of benefit and risk shifts.
• Malignant polyps, and colonoscopy before and after surgery for bowel cancer.
• Surveillance in inflammatory bowel disease: when to start, how often, which technique and what to do when dysplasia is found.
• Quality of colonoscopy, bowel preparation and the place of CT colonography.

Why the IBD section is its own problem

Surveillance in Crohn's disease and ulcerative colitis is not the same task as surveillance after a polyp. The risk relates to how much of the bowel is inflamed and for how long, dysplasia can be flat and hard to see rather than raised, and the decision when it is found ranges from a closer look to removing the colon. The section sets out when to begin surveillance, the interval, the technique and how to handle high-grade, low-grade and indefinite dysplasia.

These are the intervals quoted on the colonoscopy, bowel cancer screening and Crohn's disease and ulcerative colitis pages of this site and the reason those pages give intervals rather than generalities. How urgently a referral is seen in the New South Wales public system is a separate piece of work, described in the note on colonoscopy categorisation.

The guidelines, on the Cancer Council Australia site