Colonic adenomatous polyp with florid presence of monoclonal lambda Russell bodies: Case report and etiopathogenic hypothesis / Pólipo adenomatoso colónico con presencia florida de cuerpos de Russell monoclonales lambda: comunicación de un caso e hipótesis etiopatogénica

Russell bodies (RBs) are round eosinophilic intracytoplasmic inclusions formed by condensed immunoglobulins in mature plasma cells, which are called Mott cells. These cells are rarely found in the gastric tract, with even less cases reported in the colorectal region. There are still many questions about this event, as it is still unknown the relationship between the agents reported of increasing the probability of appearance of these cells and the generation of RBs. In this case report we describe the fifth patient presenting an infiltration of Mott cells in a colorectal polyp, being the second case with a monoclonal origin without a neoplastic cause, and the first one monoclonal for lambda. A comparison with previously similar reported cases is also done, and a possible etiopathogenic hypothesis proposed. (AU)

Los cuerpos de Russell (RB) son inclusiones intracitoplasmáticas eosinofílicas redondas formadas por inmunoglobulinas condensadas en las células plasmáticas maduras, que se denominan células de Mott. Estas células rara vez se encuentran en el tracto gástrico, y son aún más infrecuentes en la región colorrectal. Actualmente hay muchas dudas sobre este evento, ya que se desconoce la relación entre los agentes causantes de aumentar la probabilidad de aparición tanto de estas células como de la de RB. En este caso describimos al quinto paciente con un pólipo colorrectal, localizado en el tracto colorrectal e infiltrado por células de Mott, siendo el segundo caso de origen monoclonal sin causa neoplásica y el primero monoclonal para lambda. También se hace una comparación con casos similares previamente reportados y se propone una hipótesis etiopatogénica. (AU)

Pólipo de Nakamura, un hallazgo extraordinariamente infrecuente / Nakamura polyp, an extraordinarily rare finding

El pólipo mioglandular inflamatorio o de Nakamura es un pólipo muy infrecuente, habiendose descrito en la literatura unos 100 casos. Posee unas características tanto endoscópicas como histológicas específicas, cobrando gran importancia su conocimiento para su diagnóstico adecuado. Es de vital importancia su diagnóstico diferencial con otro tipo de pólipos tanto histológicamente como respecto a su seguimiento endoscópico. Presentamos el caso clínico de un pólipo de Nakamura como hallazgo incidental en una colonoscopia de cribado.(AU)

Underwater versus conventional endoscopic mucosal resection for sessile colorectal polyps: an updated systematic review and meta-analysis

Background: underwater endoscopic mucosal resection (uEMR) without submucosal injection for sessile colorectal polyps was introduced as a new replacement for conventional EMR (cEMR). However, the optimal resection strategy remains a topic of debate. Hence, this meta-analysis was performed to compare the efficacy and safety of uEMR and cEMR in patients with sessile colorectal polyps. Methods: a comprehensive search of the literature from 2000 till January 2022 was performed from Medline, CENTRAL and Embase for randomized controlled trials (RCTs) comparing cEMR vs uEMR for colorectal polyps. The evaluated outcomes included en bloc resection, R0 resection, procedure time, overall bleeding and recurrence. Pooled risk ratios (RR) with 95 % confidence interval were calculated using a random effect model. Results: six studies were included, out of which four were full-text articles and two were conference abstracts. En bloc resection (RR 1.26, 95 % CI: 1.00-1.60), R0 resection (RR 1.10, 95 % CI: 0.96-1.26), overall bleeding (RR 0.85, 95 % CI: 0.54-1.34) and recurrence rate (RR 0.75, 95 % CI: 0.45-1.27) were comparable between uEMR and cEMR. However, uEMR was associated with a shorter procedure time (mean difference [MD] -1.55 minutes, 95 % CI: -2.71 to -0.39). According to the subgroup analysis, uEMR led to a higher rate of en bloc resection (RR 1.41, 95 % CI: 1.07-1.86) and R0 resection (RR 1.19, 95 % CI: 1.01-1.41) for polyps ≥ 10 mm in size. Conclusion: both uEMR and cEMR have a comparable safety and efficacy. For polyps larger than 10 mm, uEMR may have an advantage over cEMR and should be the topic for future studies (AU)

Development of knowledge-based clinical decision support system for patients included in colorectal screening program / Desarrollo de un sistema de soporte a la decisión médica basado en el conocimiento para los pacientes incluidos en el programa de cribado del cáncer colorrectal

Background & aims: Colorectal (CRC) screening programs represent a large volume of procedures that need a follow-up endoscopy. A knowledge-based clinical decision support system (K-CDSS) is a technology which contains clinical rules and associations of compiled data that assist with clinical decision-making tasks. We develop a K-CDSS for management of patients included in CRC screening and surveillance of colorectal polyps. Methods: We collected information on 48 variables from hospital colonoscopy records. Using DILEMMA Solutions Platform © (https://www.dilemasolution.com) we designed a prototype K-CDSS (PoliCare CDSS), to provide tailored recommendations by combining patients data and current guidelines recommendations. The accuracy of rules was verified using four scenarios (normal colonoscopy, lesions different than polyps, non-advanced adenomas and advanced adenomas). We studied the degree of agreement between the clinical assessments made by expert doctors and nurses equipped with PoliCare CDSS. Two experts confirmed a correlation between guidelines and PoliCare recommendations. Results: 56 consecutive endoscopy cases from colorectal screening program were included (62.8 years; range 53-71). Colonoscopy results were: absence of colon lesions (n=7, 12.5%), lesions in the colon that are not polyps (n=3, 5.4%) and resected colonic polyps (n=46, 82.1%; 100% R0 resection). Patients with resected polyps presented non-advanced adenoma (n=21, 45.6%) or advanced lesions (n=25, 54.4%). There were no differences in erroneous orders with PoliCare CDSS (Kappa value 1.0). Conclusions: PoliCare CDSS can easily be integrated into the workflow for improving the overall efficiency and better adherence to evidence-based guidelines.(AU)

Antecedentes & objetivos: Los programas de cribado de cáncer colorrectal (CCR) generan un gran número de colonoscopias de seguimiento. Un sistema de soporte a la decisión clínica basado en el conocimiento (K-CDSS) es una tecnología que contiene reglas clínicas y asociaciones de datos que ayudan en la tarea de toma de decisiones clínicas. El objetivo fue desarrollar un K-CDSS para el manejo de los pacientes de cribado de CCR, y evaluar su eficacia. Métodos: Recolectamos información de 48 variables de registros de colonoscopia. Mediante el software DILEMMA (https://www.dilemasolution.com) diseñamos un prototipo de K-CDSS (PoliCare CDSS), para proporcionar recomendaciones personalizadas, combinando los datos de los pacientes y las recomendaciones de las guías actuales. La exactitud de las reglas se verificó mediante cuatro escenarios (colonoscopia normal, lesiones diferentes a pólipos, adenomas no avanzados y adenomas avanzados). Se estudió el grado de concordancia entre las valoraciones clínicas realizadas por médicos expertos y enfermeros equipados con PoliCare CDSS. Dos expertos confirmaron una correlación entre las pautas y las recomendaciones de PoliCare. Resultados: Se incluyeron 56 casos consecutivos del programa de cribado (62,8 años; rango 53-71). Los resultados de la colonoscopia fueron: ausencia de lesiones de colon (n = 7, 12,5%), lesiones en el colon que no son pólipos (n = 3, 5,4%) y pólipos de colon resecados (n = 46, 82,1%; resección R0 del 100%). Los pacientes con pólipos resecados presentaron adenoma no avanzado (n = 21, 45,6%) o lesiones avanzadas (n = 25, 54,4%). No hubo diferencias en recomendaciones erróneas con PoliCare CDSS (valor Kappa 1.0). Conclusiones: PoliCare CDSS se puede integrar fácilmente en el flujo de trabajo de una unidad de endoscopia digestiva.(AU)

Post-polypectomy colonoscopy surveillance: Can we improve the diagnostic yield? / Vigilancia tras resección de pólipos de colon: ¿podemos mejorar el rendimiento diagnóstico?

Although adenomas and serrated polyps are the preneoplastic lesions of colorectal cancer, only few of them will eventually progress to cancer. This review provides a comprehensive overview of the present and future of post-polypectomy colonoscopy surveillance. Post-polypectomy surveillance guidelines have recently been updated and all share the aim towards more selective and less frequent surveillance. We have examined these current guidelines and compared the recommendations of each of them. To improve the diagnostic yield of post-polypectomy surveillance it is important to find predictors of metachronous polyps that better identify high-risk individuals of developing advanced neoplasia. For this reason, we have also conducted a literature review of the molecular biomarkers of metachronous advanced colorectal polyps. Finally, we have discussed future directions of post-polypectomy surveillance and identified possible strategies to improve the use of endoscopic resources with the COVID-19 pandemic.(AU)

Aunque los adenomas y los pólipos serrados son las lesiones preneoplásicas del cáncer colorrectal, solo algunas de ellas progresarán a cáncer. Esta revisión presenta una descripción del presente y el futuro de la vigilancia endoscópica tras la resección de pólipos. Las recomendaciones de vigilancia pospolipectomía se han actualizado recientemente y todas comparten el objetivo de una vigilancia más selectiva y menos frecuente. Hemos examinado estas directrices actuales y hemos comparado las recomendaciones de cada una de ellas. Para mejorar el rendimiento diagnóstico de la vigilancia posterior a la polipectomía es importante encontrar predictores de pólipos metacrónicos que identifiquen mejor a los individuos con alto riesgo de desarrollar neoplasias avanzadas. Por este motivo, también hemos realizado una revisión de la literatura de los biomarcadores moleculares de pólipos avanzados metacrónicos. Finalmente, hemos discutido las direcciones futuras de la vigilancia endoscópica tras la resección de pólipos e identificado posibles estrategias para mejorar el uso de recursos endoscópicos con la pandemia de COVID-19.(AU)

Participation in clinical trials increases the detection of pre-malignant lesions during colonoscopy

Background: colorectal adenoma detection has been associated with the effectiveness of cancer prevention. Clinical trials have been designed to determine the role of several interventions to increase the detection of pre-malignant lesions. We hypothesized that colonoscopy in the setting of clinical trials has a higher pre-malignant lesion detection rate.Methods: a cross-sectional study was performed that compared the detection of pre-malignant lesions in 147 randomly sampled non-research colonoscopies and 294 from the control group of two prospective trials. Outpatients aged 40-79 years, with no personal history of colorectal cancer (CRC) were included.Results: baseline characteristics were similar between the two groups. The pre-malignant lesion detection rate in the trial vs control group was 65.6 % vs 44.2 % (OR 2.411; 95 % CI: 1.608-3.614; p < 0.001), the polyp detection rate was 73.8 % vs 59.9 % (OR 1.889; 95 % CI: 1.242-2.876; p = 0.003), the adenoma detection rate was 62.6 % vs 44.2 % (OR 2.110; 95 % CI: 1.411-3.155; p < 0.001) and the sessile serrated lesion detection rate was 17 % vs 4.1 % (OR 4.816; 95 % CI: 2.014-11.515; p < 0.001). The mean number of pre-malignant and sessile serrated lesions was 1.70 vs 1.06 (p = 0.002) and 0.32 vs 0.06 (p = 0.001) lesions per colonoscopy, respectively. There was no significant change in any of the study outcomes according to the multivariate analysis with each single potential confounder.Conclusions: patients involved in colonoscopy trials may benefit from higher quality examinations, as shown by the higher detection rates. Institutions should consider supporting clinical research in colonoscopy as a simple means to improve colonoscopy quality and colorectal cancer prevention. (AU)

Cirugía endoscópica y laparoscópica combinada para el tratamiento de pólipos de colon benignos complejos (CELS): estudio observacional / Combined endoscopic and laparoscopic surgery for the treatment of complex benign colonic polyps (CELS): observational study

Introducción: La cirugía endoscópica y laparoscópica combinada (CELS) ha surgido como un método para el tratamiento de lesiones colónicas benignas complejas que, de otro modo, requerirían una resección quirúrgica. El objetivo de este estudio es describir las distintas técnicas CELS y evaluar su seguridad, en un procedimiento escasamente difundido en nuestro entorno.MétodoEstudio observacional, retrospectivo, donde se evaluaron los resultados a corto plazo de pacientes diagnosticados de pólipos no resecables endoscópicamente sometidos a CELS entre octubre del 2018 a junio del 2020. Se valoraron los resultados postoperatorios, la estancia hospitalaria y los hallazgos patológicos.ResultadosDiecisiete pacientes consecutivos fueron sometidos a CELS durante el período de estudio. El tamaño medio de la lesión fue de 3,5 cm (rango 2,5 a 6,5 cm), la localización más recurrente fue el ciego (10 de 17). La técnica CELS más frecuente aplicada fue la resección en cuña laparoscópica asistida por endoscopia (11 de 17). En cuatro pacientes, esta resección se combinó con otra técnica CELS. Dos casos se sometieron a una resección del segmento laparoscópico asistido por endoscopia. El éxito de CELS en nuestra serie fue en 14 de 17 (82,4%). La mediana del tiempo quirúrgico y estancia hospitalaria fue de 85 min (rango 50 a 225 min) y de dos días (rango uno a 15 días), respectivamente. Solo un paciente presentó infección del órgano-cavitaria que no requirió cirugía adicional.ConclusionesCELS es una técnica segura multidisciplinar, que requiere la colaboración entre gastroenterólogos y cirujanos. Se puede considerar como una alternativa a la resección de colon para pólipos benignos complejos(AU)

Purpose: Combined endoscopic and laparoscopic surgery (CELS) has emerged as a promising method for managing complex benign lesions that would otherwise require major colonic resection. The aim of this study was to describe the different techniques and to evaluate the safety of CELS, assess its outcomes in a technique that is scarcely widespread in our environment.MethodObservational retrospective study, short-term outcomes of patients undergoing CELS for benign colon polyps from October 2018 to June 2020 were evaluated. Postoperative outcomes, length of hospital stay and pathological findings were evaluated.ResultsSeventeen consecutive patients underwent CELS during the study period. The median size of the lesion was 3.5 cm (range 2.5 – 6.5 cm), the most frequent location was the cecum (10 from 17). Most patients treated with CELS underwent an endoscopic-assisted laparoscopic wedge resection (11 from 17). In four patients this resection was combined with another CELS technique, and two patients underwent an endoscopic-assisted laparoscopic segment resection. The success rate of CELS in our series was in 14 from 17 (82,4%). The median operative time was 85 min (range 50-225 min). The median hospital stay was 2 days (range 1-15 days). One patient experienced an organ/space surgical site infection which did not require further intervention. Four lesions were shown to be malignant by postoperative pathology study.ConclusionCELS is a safe and multidisciplinar technique that requires collaboration between gastroenterologists and surgeons. It can be considered as an alternative to colonic resection for complex benign colonic polyps(AU)

Recomendaciones prácticas para una adecuada vigilancia pospolipectomía endoscópica desde atención primaria / No disponible

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Schwann cell hamartoma as an incidental finding in a colonoscopy / Hamartoma de células de Schwann como hallazgo incidental en una colonoscopia

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Adenocarcinoma de colon sobre adenoma serrado tradicional / No disponible

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Potential utility of dedicated non-magnified endoscopy for identification of open pit pattern in sessile serrated adenoma/polyp / Posible utilidad de la endoscopia no magnificada específica para la identificación del patrón críptico abierto en el adenoma/pólipo sésil serrado

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Tecnologías de endoscopia avanzada para mejorar la detección y caracterización de los pólipos colorrectales / Advanced endoscopy technologies to improve the detection and characterisation of colorrectal polyps

El cáncer colorrectal constituye un problema de salud importante. Se ha demostrado una mejoría de la supervivencia mediante la realización de colonoscopias de cribado y la extirpación de sus lesiones precursoras, los pólipos. Sin embargo, la colonoscopia no es infalible y se han propuesto múltiples estrategias dirigidas a mejorar la calidad de la misma. En esta revisión se describen los sistemas endoscópicos de que disponemos para mejorar la detección y caracterización de los pólipos, las diferentes clasificaciones utilizadas para la predicción histológica y las indicaciones actuales de las técnicas de diagnóstico endoscópico avanzado

Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques

Regresión de pseudopólipo gigante en paciente con enfermedad de Crohn del colon tras tratamiento con infliximab / Regression of a giant pseudopolyp in a patient with colonic Crohn's disease after therapy with infliximab

Los pseudopólipos inflamatorios gigantes (> 15 mm) son una complicación infrecuente de la enfermedad inflamatoria intestinal (EII). Es difícil el diagnóstico diferencial con adenomas y carcinomas. Aunque suelen ser asintomáticos, debido a su tamaño pueden ocasionar obstrucción o invaginación intestinal. El manejo habitual se realiza con biopsias de la lesión y extirpación endoscópica de la misma en casos seleccionados, reservando la cirugía para complicaciones inherentes a su tamaño o bien ante la duda anatomopatológica. Presentamos el caso de una paciente de 43 años con enfermedad de Crohn (EC) de colon en remisión clínica y sin tratamiento específico para la enfermedad en la que en una colonoscopia de cribado se identificó un pseudopólipo gigante (40 mm). Se inició tratamiento con infliximab y azatioprina para intentar reducir tamaño y permitir resección endoscópica posteriormente. Tras dosis de inducción, en las semanas 0, 2 y 6 se realizó una nueva colonoscopia que evidenció una clara reducción de tamaño de la lesión. Se intentó resección mucosa pero no fue posible por la intensa fibrosis que impedía elevación de la lesión tras inyección en su base. Una nueva colonoscopia de control a los tres meses confirmó, sin embargo, la desaparición completa de la lesión. Los datos en la literatura respecto al manejo terapéutico de los pseudopólipos gigantes son escasos, pero se ha publicado que es poco frecuente que desaparezcan con tratamiento médico, requiriendo resección quirúrgica o endoscópica

Giant inflammatory pseudopolyps (> 15 mm) are an uncommon complication of inflammatory bowel disease (IBD) and a differential diagnosis with adenomas and carcinomas is challenging. Although usually asymptomatic, they may result in intestinal obstruction or intussusception due to their size. The standard management involves lesion biopsies and endoscopic excision for selected cases; surgery is usually reserved for size-associated complications or an uncertain pathology. We report the case of a 43-year-old female patient with Crohn's disease (CD) in clinical remission, with no specific treatment at the time. A giant pseudopolyp of 40-mm was found during a screening colonoscopy. Therapy was initiated with infliximab and azathioprine in an attempt to reduce the size of the polyp and allow an endoscopic resection. Additional colonoscopies were performed following induction doses at weeks 0, 2, and 6, which revealed a reduced lesion size. Mucosal resection was attempted but failed due to severe fibrosis, which prevented base injections from lifting up the polyp. However, a follow-up colonoscopy three months later showed that the lesion had completely disappeared. The evidence in the literature regarding giant pseudopolyp management is scarce, but reports indicate that they rarely disappear with medical therapy alone and usually require surgery or endoscopic resection

Relationship between the polyp detection rate and the post-colonoscopy colorectal cancer rate

Aim: the adenoma detection rate is the quality indicator of colonoscopy that is most closely related to the development of interval colorectal cancer or post-colonoscopy colorectal cancer. However, the recording of this indicator in different units of gastrointestinal endoscopy is obstructed due to the large consumption of resources required for its calculation. Several alternatives have been proposed, such as the polyp detection rate. The objective of this study was to evaluate the relationship between the polyp detection rate and its influence on post-colonoscopy colorectal cancer rate. Patients and methods: in this study, 12,482 colonoscopies conducted by 14 endoscopists were analyzed. The polyp detection rate was calculated for each endoscopist. Endoscopists were grouped into quartiles (Q1, Q2, Q3, and Q4), from lowest to highest polyp detection rate, in order to evaluate whether there were any differences in the development of post-colonoscopy colorectal cancer. Results: the lowest polyp detection rate was 20.66% and the highest was 52.16%, with a median of 32.78 and a standard deviation of +/- 8.54. A strong and positive association between polyp endoscopy diagnosis and adenoma histopathology result was observed and a linear regression was performed. A significantly higher post-colonoscopy colorectal cancer rate was observed in the group of endoscopists with a lower polyp detection rate (p < 0.02). Conclusion: polyp detection rate is a valuable quality indicator of colonoscopy and its calculation is much simpler than that of the adenoma detection rate. In our study, the prevalence of post-colonoscopy colorectal cancer was inversely and significantly related to the endoscopists' polyp detection rate

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Efecto de la sedación consciente con midazolam y fentanilo sobre la calidad global de la colonoscopia. Estudio prospectivo y aleatorizado / Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study

Introducción: estudio prospectivo y aleatorizado para valorar la influencia de la sedación consciente, con midazolam y fentanilo, sobre la calidad global de la colonoscopia, cuantificando simultáneamente su efecto sobre la calidad científica, la calidad percibida y la seguridad del paciente. Método: se incluyeron prospectivamente pacientes remitidos para colonoscopia y se aleatorizaron para recibir o no sedación. Se recogieron datos demográficos, indicación de la colonoscopia, intubación cecal, grado de limpieza colónica, tiempo de introducción y retirada, adenomas resecados y complicaciones durante la exploración y recuperación del paciente. Treinta días después se realizó un cuestionario de satisfacción (GHAA 9-me) y se preguntó por las complicaciones tras la exploración. Resultados: se incluyeron 5.328 pacientes (edad 62 +/- 15,22; 47% varones; 3.734 sedados y 1.594 sin sedación). Los pacientes sedados mostraron menor tiempo de introducción del endoscopio (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,019), mayor tasa de intubaciones del ciego (96% vs. 88%; p < 0,05), tiempo de retirada más prolongado (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,01) y mayor tasa de adenomas (22% vs. 17; p < 0,05), adenomas avanzados (8% vs. 4,3%; p < 0,05) y pólipos serrados (1,9% vs. 0,6%; p = 0,05). El uso de sedación disminuyó las molestias durante y después de la exploración, sin aumentar las complicaciones. La puntuación del cuestionario de satisfacción fue mayor (23,6 +/- 1,5 vs. 16,6 +/- 4,8; p < 0,001) en los pacientes sedados. Conclusiones: la sedación superficial con midazolam y fentanilo no solo disminuye las molestias de los pacientes, sino que mejora la calidad global de la colonoscopia. Por esto, debemos considerar el uso de sedación como una parte imprescindible de la colonoscopia

Introduction: a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. Methods: patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. Results: a total of 5,328 patients were included, the average age was 62 +/- 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 +/- 1.5 vs 16.6 +/- 4.8, p < 0.001) in the sedated patients. Conclusions: superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy

A granular cell tumor: an unusual colon polyp

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Vigilancia tras resección de pólipos de colon y de cáncer colorrectal. Actualización 2018 / Endoscopic surveillance after colonic polyps and colorrectal cancer resection. 2018 update

La evidencia disponible para estratificar el riesgo de presentar un cáncer colorrectal metacrónico tras la extirpación de pólipos colorrectales y determinar los intervalos de vigilancia es limitada y se basa en estudios observacionales. No obstante, a la espera de nuevas evidencias, es necesario unificar los criterios del seguimiento endoscópico en nuestro medio. Por ello, desde las principales sociedades científicas involucradas en el manejo de estos pacientes, como son la Asociación Española de Gastroenterología, la Sociedad Española de Medicina Familiar y Comunitaria, la Sociedad Española de Endoscopia Digestiva y el Grupo de Cribado de Cáncer Colorrectal de la Sociedad Española de Epidemiología, se ha creado este documento de consenso, que se encuentra incluido en el capítulo 10 de la «Guía de Práctica Clínica de Diagnóstico y Prevención del Cáncer Colorrectal. Actualización 2018». A continuación, se presentarán importantes novedades respecto a la edición previa publicada en 2009. En primer lugar, se establecen situaciones que requieren y no requieren vigilancia endoscópica y se elimina la necesidad de realizar seguimiento en individuos que no presentan un riesgo especial de cáncer de colon metacrono. En segundo lugar, se establecen recomendaciones de vigilancia endoscópica en individuos con pólipos serrados. Finalmente, a diferencia de la edición anterior, se dan recomendaciones de vigilancia endoscópica en individuos intervenidos por cáncer colorrectal. Paralelamente, supone un avance sobre la guía europea de calidad en el cribado del cáncer colorrectal, ya que elimina la división entre grupo de riesgo medio y grupo de riesgo alto, lo que supone la eliminación de una proporción considerable de colonoscopias de vigilancia precoz. Finalmente, se dan recomendaciones claras sobre la ausencia de necesidad de seguimiento en el grupo de riesgo bajo, para el que la guía europea mantenía cierta ambigüedad

There is limited scientific evidence available to stratify the risk of developing metachronous colorectal cancer after resection of colonic polyps and to determine surveillance intervals and is mostly based on observational studies. However, while awaiting further evidence, the criteria of endoscopic follow-up needs to be unified in our setting. Therefore, the Spanish Association of Gastroenterology, the Spanish Society of Family and Community Medicine, the Spanish Society of Digestive Endoscopy, and the Colorectal Cancer Screening Group of the Spanish Society of Epidemiology, have written this consensus document, which is included in chapter 10 of the "Clinical Practice Guideline for Diagnosis and Prevention of Colorectal Cancer. 2018 Update". Important developments will also be presented as regards the previous edition published in 2009. First of all, situations that require and do not require endoscopic surveillance are established, and the need of endoscopic surveillance of individuals who do not present a special risk of metachronous colon cancer is eliminated. Secondly, endoscopic surveillance recommendations are established in individuals with serrated polyps. Finally, unlike the previous edition, endoscopic surveillance recommendations are given in patients operated on for colorectal cancer. At the same time, it represents an advance on the European guideline for quality assurance in colorectal cancer screening, since it eliminates the division between intermediate risk group and high risk group, which means the elimination of a considerable proportion of colonoscopies of early surveillance. Finally, clear recommendations are given on the absence of need for follow-up in the low risk group, for which the European guidelines maintained some ambiguity