Colonoscopy Clinical Practice Guidelines (AGA, 2021)

American Gastroenterological Association

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

September 03, 2021

Clinical guidelines in the form of best practice advice statements on improving the quality of screening and surveillance colonoscopy were published in August 2021 by the American Gastroenterological Association (AGA) in  Gastroenterology.[1]

Bowel preparation quality should be measured by endoscopy units, on a unit level, at least annually. Screening and surveillance colonoscopies should be associated with adequate bowel preparation (ie, a Boston Bowel Preparation Scale [BBPS] score ≥6, with each segment score ≥2) in at least 90% of procedures, with the aspirational target being 95% or above.

In patients undergoing colonoscopy, split-dose bowel preparation should serve as the endoscopy unit's standard preparation strategy.

High-definition colonoscopes should be used by endoscopy units for screening and surveillance colonoscopy.

To improve polyp detection, endoscopists should give the right colon a second look, either in retroflexed or forward view.

Endoscopy units should, at the endoscopist and unit level, routinely measure the adenoma detection rate and provide feedback on it, doing so at least annually or when 250 screening colonoscopies have been accrued by the endoscopists.

Individual endoscopists should have a goal adenoma detection rate of 30% or above, with the aspirational target being at least 35%. When these thresholds are not met, endoscopists "may consider extending withdrawal times, self-learning regarding mucosal inspection and polyp identification, peer feedback, and other educational interventions."

Serrated lesion detection rates should be measured by endoscopy units on an endoscopist and unit level, with the unit providing feedback on these values. For serrated lesion detection, an individual endoscopist should have a goal rate of 7% or higher, with the aspirational target being at least 10%. Low rates should be addressed with improvement efforts oriented toward colonoscopists and pathologists.

For nonpedunculated polyps 3-9 mm in size, cold snare polypectomy should be employed, with aim taken at "a small rim of normal tissue around the polyp." Polyps that are over 2 mm in size should generally not be addressed with forceps.

If overt malignant endoscopic features are not present and patient pathology is not consistent with invasive adenocarcinoma, individuals with complex polyps should be evaluated by an expert in polypectomy with regard to the use of endoscopic resection.

Endoscopists should, when assigning appropriate screening and surveillance intervals, follow current guidelines. Repeat colonoscopy should be performed in 3 years on all patients with advanced adenomas. If, in average-risk patients, screening colonoscopies are normal or only small distal hyperplastic polyps are present, repeat examinations should not be performed before 10 years.

For more information, please go to Colonoscopy.

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