Hello again, everyone. My name is Joe Vacari, Co-Chair of ASGE APP Task Force. I'm one of the faculty members of this year's ASGE APP Annual Advanced Practical Provider Course, which will take place on March 31st and April 1st. This will be the last of our video tips of the week, so I hope you have been enjoying them and I hope you enjoy this one. And as I've said in each of the previous ones, I know everyone is busy, so we'll get right into it and make this an effective and efficient learning tool. This week's topic is colorectal cancer screening. Screening colonoscopy in average risk patients begins at age 45 and continues through age 75. Remember that screening needs to be individualized for those age 76 to 85, and it's based on shared decision-making between patients and their doctors. So if a patient between the age of 76 and 85 would like to proceed with screening, that's an important discussion to take place, looking at the benefits and risks of proceeding with screening. Screening tests for colorectal cancer include colonoscopy, fecal immunochemical test, or FIT, and multi-target stool DNA test with FIT, which we know as MTSDNA stool testing. The United States Multi-Society Task Force for Colorectal Cancer ranks colonoscopy and FIT tests as Tier 1 tests, so those are the preferred tests, and the MTSDNA is a Tier 2 test. Colonoscopy is the gold standard test for colorectal cancer screening based on its sensitivity for pulp detection and its ability to resect pulps at the same time. I think that's an important point. This is the one test that can diagnose and remove polyps in the same setting. Sixty to ninety percent of colorectal cancers can be prevented with colonoscopy and polypectomy. If colonoscopy is unsuccessful due to difficult anatomy, remember that CT colonography or CT calligraphy should be considered to complete the screening process. The following intervals should be followed for screening modalities in average-risk patients with normal finding. I think this is a very important point. We do not want to over use our tests, and we want to use our tests in the appropriate manner, so if a screening test is performed and it is negative, the following intervals should occur. Colonoscopy every 10 years after a negative screening colonoscopy. After a negative FIT test, a FIT test should be performed every year. If the MTSDNA is used as your screening test and is negative, it should be repeated every three years, and if CT calligraphy is used for screening tests, it should be repeated every five years. I'd like to spend the last part of this video tip on surveillance intervals. This is also a very important topic because we want to get the surveillance intervals right to avoid overuse and to appropriately take care of our patients delivering high quality care. Surveillance intervals after polypectomy are based on number, size, and histology of the lesions. The following surveillance intervals are recommended. For adenomas, low-risk tubular adenoma, so a tubular adenoma less than 10 millimeters, follow-up is 7 to 10 years. If a patient has 3 to 4 tubular adenomas that are less than 10 millimeters, the interval is 3 to 5 years. For high-risk adenoma or adenomas, the definition of high-risk includes a high-risk adenoma of greater than or equal to 10 millimeters in size. Any villus component to the pathology, so tubular villus or villus component to pathology is high risk. High-grade dysplasia is high risk. If you have a patient with any of these high-risk adenomas, the surveillance interval is 3 years. For hyperplastic polyps and those patients with less than or equal to 20 hyperplastic polyps, all less than 10 millimeters in the left colon, repeat colonoscopy should be 10 years. For hyperplastic polyp greater than or equal to 10 millimeters, the follow-up is 3 to 5 years. For hyperplastic polyps in the right colon, one should follow the same surveillance intervals as adenomas. And finally, sessile serrated polyps or SSP, SSPs. If a patient has 1 to 2 SSPs that are less than 10 millimeters, the follow-up is 5 to 10 years. If a patient has an SSP greater than or equal to 10 millimeters or 3 to 4 SSPs less than 10 millimeters, then the follow-up is 3 years. As I said, this is our last video tip of the week. I hope you have enjoyed these short bursts of what I think is high-quality and efficient education. I've enjoyed doing them. And one last reminder, our annual GI Advanced Practice Provider course will be on March 31st and April 1st. We really love to have as many people as possible. It's very fun. It's a great learning environment. The faculty are very interested in teaching and believe that teaching APPs is one of the most important things that we can do to provide high-quality care. So last year, we had over 200 people. So I hope we can top that. And many of you can join us at this year's course. We'd love to have you. And as I've signed off on the previous ones, remember we are all in this together. Our goal is to build high-quality GI physician APP teams delivering high-quality care to our patients. I look forward to seeing you at the course.

colorectal cancer screening

surveillance intervals

personalized screening

colonoscopy

FIT tests