DDSEP® 8 Quick Quiz

December 2016 Quiz 2

Publish date: December 2, 2016

Q2: A 67-year-old man undergoes a colonoscopy for rectal bleeding. The preparation is adequate and the colonoscopy is complete to the cecum. He is noted to have a 9-mm flat polyp in the ascending colon as well as 2 polyps measuring 4-5 mm in the rectosigmoid colon. These are completely excised. The pathology of the ascending colon polyp shows a sessile serrated polyp without dysplasia, while the rectosigmoid polyps are hyperplastic.

Which one of the following is the recommended follow-up for surveillance?

1 year

5 years

3 years

6 months

7 years

Q2: Answer: B

Rationale: This patient has a sessile serrated polyp without dysplasia located in the right colon as well as hyperplastic polyps in the rectosigmoid. Serrated polyps are thought to be precursor lesions to colon cancers arising from gene hypermethylation. Serrated polyps may be difficult to detect as they are flat or sessile, have indiscrete borders, and adherent mucus. Recent guidelines from the Multi-Society Task Force recommend that these lesions be treated in a way similar to that of adenomas for surveillance. Serrated polyps less than 10 mm without dysplasia should be surveyed in 5 years. Serrated polyps greater than 10 mm with or without dysplasia should be managed in a way similar to that of high-risk adenomas, with surveillance in 3 years. Hyperplastic polyps in the rectum do not require intensified surveillance.

Reference

1. Lieberman, D.A., Rex, D.K., Winawer, S.J., et al. Guidelines for colonoscopy surveillance after screening and polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844.

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