What are the guideline sources, guidelines and references for Colonoscopy ?
Guideline sources The following summarized guidelines for the evaluation and management of colonoscopy are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG/CAG 2022), the European Society of Gastrointestinal Endoscopy (ESGE/BSG 2021), the American Gastroenterological Association (AGA 2021), the European Society of Gastrointestinal Endoscopy (ESGE 2021), and the American Society for Gastrointestinal Endoscopy (ASGE 2020; 2018; 2016). 1 2 3 4 5 6 7 Guidelines 1. Diagnostic procedures Tissue sampling (IBD): consider performing segmental biopsies (at least 2 from each segment) placing biopsies in different specimen containers (ileum, cecum, ascending, transverse, descending, and sigmoid colon, and rectum) in patients with clinical and endoscopic signs of colitis. C Show 8 more Tissue sampling (premalignant and malignant lesions): perform full excision rather than biopsy in patients with adequately assessed colorectal polyps judged to be premalignant. B Show 3 more https://web.pathway.md/diseases/recWfcIb4DpToAXdJ 1/6 6/23/23, 3:35 AM Colonoscopy Pathway 2. Medical management Management of antiplatelet therapy, preprocedural: As per CAG/ACG 2022 guidelines, insufficient to recommend for or against temporary interruption of the P2Y12 inhibitor in patients on single antiplatelet therapy with P2Y12 inhibitor agents undergoing elective endoscopic gastrointestinal procedures. E Show 2 more As per ESGE/BSG 2021 guidelines, counsel all patients on the thrombotic risks of discontinuing antiplatelets, as well as the hemorrhagic risks of continuing therapy. B Show 4 more As per ASGE 2016 guidelines, consider continuing low doses of aspirin and NSAIDs in the periendoscopic period. C Show 4 more Management of antiplatelet therapy, postprocedural: As per CAG/ACG 2022 guidelines, insufficient evidence to recommend for or against resuming P2Y12 inhibitor on the same day of the procedure versus 1-7 days after the procedure in patients interrupted the P2Y12 inhibitor in the periprocedural period for elective endoscopic gastrointestinal procedures. I As per ESGE/BSG 2021 guidelines: Resume antiplatelet therapy, if discontinued preprocedurally, up to 2-3 days after the procedure depending on the perceived hemorrhagic and thrombotic risks. B Counsel all patients on antiplatelets about the increased risk of postprocedural hemorrhage. B Management of antiplatelet therapy, acute GI bleeding: As per ESGE/BSG 2021 guidelines, consider discontinuing aspirin permanently for primary prophylaxis. C Show 2 more As per ASGE 2016 guidelines: Consult with the prescribing specialist (or their colleague) before stopping antiplatelets in situations of significant gastrointestinal bleeding in patients with recently (< 1 year) placed drug-eluting intracoronary stents, within 30 days after insertion of a bare metal intracoronary stent, or within 90 days of acute coronary syndrome. Recognize that the risk of an adverse cardiac event associated with cessation of the antiplatelet therapy likely exceeds the benefit of decreasing postendoscopic bleeding. B Keep antiplatelet agents in patients on antiplatelet therapy with life-threatening or serious gastrointestinal bleeding after discussion with their cardiologist. B Management of anticoagulant therapy, preprocedural: As per CAG/ACG 2022 guidelines, consider continuing warfarin rather than temporarily interrupting (1-7 days) in patients on warfarin undergoing elective/planned endoscopic gastrointestinal procedures. C https://web.pathway.md/diseases/recWfcIb4DpToAXdJ 2/6 6/23/23, 3:35 AM Colonoscopy Pathway Show 2 more As per ESGE/BSG 2021 guidelines, counsel all patients on the thrombotic risks of discontinuing anticoagulants, as well as the hemorrhagic risks of continuing therapy. B Show 5 more As per ASGE 2016 guidelines, defer elective endoscopic procedures until short-term anticoagulation therapy (such as warfarin for VTE) is completed. B Show 3 more Management of anticoagulant therapy, postprocedural: As per CAG/ACG 2022 guidelines: Insufficient evidence to recommend for or against resuming warfarin on the same day of the procedure versus 1-7 days after the procedure in patients interrupted warfarin in the periprocedural period for elective endoscopic gastrointestinal procedures. I Insufficient evidence to recommend for or against resuming the direct OAC on the same day of the procedure versus 1-7 days after the procedure in patients interrupted the direct OAC in the periprocedural period for elective endoscopic gastrointestinal procedures. I As per ESGE/BSG 2021 guidelines: Resume anticoagulant therapy, if discontinued preprocedurally, up to 2-3 days after the procedure depending on the perceived hemorrhagic and thrombotic risks. B Counsel all patients on anticoagulants about the increased risk of postprocedural hemorrhage. B As per ASGE 2016 guidelines: Consider resuming warfarin on the same day as the procedure in all patients not having ongoing bleeding. C Consider delaying reinitiation of direct acting anticoagulants after high-risk endoscopic procedures until adequate hemostasis is ensured, given their rapid onset of action and lack of reversal agents. Consider administering thromboprophylaxis (UFH, bridge) if therapeutic doses of direct acting anticoagulants cannot be restarted within 12-24 hours after a high-risk endoscopic procedure, to decrease the risk of thromboembolism, given the short half-life of the direct acting anticoagulant agent, in patients with a high risk for thromboembolism. C Management of anticoagulant therapy, acute GI bleeding: As per ESGE/BSG 2021 guidelines, withhold OAC and correct coagulopathy according to the severity of hemorrhage and the patient's thrombotic risk in coordination with a consultant cardiologist/hematologist. Ensure that the correction of coagulopathy does not delay endoscopy or radiological intervention. B Show 3 more As per ASGE 2016 guidelines, keep anticoagulant agents in patients with acute gastrointestinal bleeding on anticoagulation therapy to facilitate achievement of hemostasis. B Show 3 more 3. Patient education https://web.pathway.md/diseases/recWfcIb4DpToAXdJ 3/6 6/23/23, 3:35 AM Colonoscopy Pathway Preprocedural counseling: inform patients undergoing colonoscopy of the potential for adverse events, warning symptoms, and emergency contact information. B Show 2 more 4. Follow-up and surveillance Post-procedural monitoring: consider obtaining systematic monitoring of delayed adverse events, including postprocedural bleeding, perforation, hospital readmission, 30-day mortality, and/or interval colorectal cancer cases, and report these adverse event rates at the endoscopy unit level. C Surveillance colonoscopy: follow current guidelines to assign appropriate screening and surveillance intervals. B Show 2 more 5. Quality improvement Requirements for bowel preparation: Endoscopy units should measure bowel preparation quality routinely, at a minimum annually, on a unit level. Adequate bowel preparation, defined as a Boston Bowel Preparation Scale score 6, with each segment (the right colon including the cecum and ascending colon, the transverse colon including the hepatic and splenic flexures, and the left colon including the descending colon, sigmoid colon, and rectum) score 2, should be achieved in 90% ( 95% aspirational target) of screening and surveillance colonoscopies: Situation Guidance Unprepared colon segment with mucosa not seen due to solid stool that cannot be cleared 0 Portion of mucosa of the colon segment seen, but other areas of the colon segment not well seen due to staining, residual stool and/or opaque liquid 1 Minor amount of residual staining, small fragments of stool and/or opaque liquid, but mucosa of colon segment seen well 2 Entire mucosa of colon segment seen well with no residual staining, small fragments of stool or opaque liquid 3 The wording of the scale was finalized after incorporating feedback from three https://web.pathway.md/diseases/recWfcIb4DpToAXdJ 4/6 6/23/23, 3:35 AM Colonoscopy Pathway colleagues experienced in colonoscopy. B Endoscopy units should use a split-dose bowel preparation as the standard preparation strategy in patients undergoing colonoscopy. B Requirements for endoscopy devices: endoscopy units should use high-definition colonoscopes for screening and surveillance colonoscopy. B Requirements for infection control: recognize that transmission of infection as a result of gastrointestinal endoscopes is extremely rare, and most reported cases are attributable to lapses in currently accepted endoscope reprocessing protocols or to defective equipment. Show 8 more Requirements for staffing members: consider ensuring a minimum staffing of 1 endoscopy staff member (unlicensed assistive personnel or registered nurse) in the room for routine procedures without sedation. E Show 5 more Requirements for operator performance: endoscopy units should measure cecal intubation rates on an endoscopist level. Cecal intubation rates should be 90% (aspirational 95%). The cecal landmarks (appendiceal orifice and ileocecal valve) should be photodocumented in colonoscopy reports. B Show 7 more Reporting: document colonoscopy with a detailed report, including procedure indication, extent of examination, bowel preparation quality, findings and interventions, and follow-up plan with rationale. B References 1. ASGE Standards of Practice Committee, Ruben D Acosta, Neena S Abraham et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016 Jan;83 1 3 16. Open 2. ASGE Quality Assurance in Endoscopy Committee, Audrey H Calderwood, Lukejohn W Day et al. Infection control during GI endoscopy. Gastrointest Endosc. 2018 May;87 5 1167 1179. Open 3. Andrew M Veitch, Franco Radaelli, Raza Alikhan et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology BSG and European Society of Gastrointestinal Endoscopy ESGE guideline update. Gut. 2021 Sep;70 9 1611 1628. Open 4. Rajesh N Keswani, Seth D Crockett, Audrey H Calderwood. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology. 2021 Aug;161 2 701 711. Open 5. Neena S Abraham, Alan N Barkun, Bryan G Sauer et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Am J Gastroenterol. 2022 Mar 17. Open https://web.pathway.md/diseases/recWfcIb4DpToAXdJ 5/6 6/23/23, 3:35 AM Colonoscopy Pathway 6. Roos E Pouw, Raf Bisschops, Krisztina B Gecse et al. Endoscopic tissue sampling Part 2 Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy ESGE Guideline. Endoscopy. 2021 Dec;53 12 1261 1273. Open 7. Laith H Jamil, Mariam Naveed, Deepak Agrawal et al. ASGE guideline on minimum staffing requirements for the performance of GI endoscopy. Gastrointest Endosc. 2020 Apr;91 4 723 729.e17. Open 8. Calderwood AH, Chapman FJ, Cohen J et al. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc. 2014 Mar;79 3 363 72. Open https://web.pathway.md/diseases/recWfcIb4DpToAXdJ 6/6