Monday, July 12, 2010

Surveillance Colonoscopy

Screening Colonoscopy

Initial screening for colorectal cancer at 50 years of age for asymptomatic, average risk men and women with follow-up colonoscopy every 10 years if the exam is normal.

Surveillance Colonoscopy

Low-risk Patients With No Family History of Colorectal Cancer Treatments
Removal of small, hyperplastic polyps would be considered normal colonoscopy. Subsequent colonoscopy is recommended at 10 years.
Complete removal of 1 or 2 small tubular adenomas (< 1 cm) in low risk patients with no family history of colorectal cancer. Colonoscopy in 5 years after the initial polypectomy - if the next exam is normal, then the colonoscopy will be in 5-10 years, the patient can thereafter be screened as per average risk guidelines.

High-risk Patients with a Personal History of Colorectal Cancer Treatments
This refers to patients with colon or rectal cancer that has been resected with curative intent. These patients should undergo high quality peri-operative clearing. Colonoscopy should be done around the time of initial diagnosis to rule out synchronous* neoplasms, or synchronous disease
At the time of diagnosis of colon cancer Presurgical evaluation for additional synchronous cancer or neoplastic polyps – if not possible due to obstruction from the carcinoma or for other technical reasons, options include intraoperative colonoscopy or colonoscopy within 3 - 6 months of resection. If abnormal repeat in 1 year.
After resection of colorectal cancer or neoplastic polyp If complete perisurgical colonoscopy negative, subsequent colonoscopy should be offered after 3 years, and then, if normal, every 5 years
Low anterior resection of rectal cancer Colonoscopy usually done within 3-6 month intervals for the first 2-3 years, to identify local recurrence.
Pedunculated polyp containing invasive carcinoma Colonoscopic removal is adequate treatment in the uniform presence of favorable prognostic indicators.** A follow-up examination within 3 months is mandatory to confirm the presence or absence of residual or recurrent disease

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