Table 7.

Short version: statements pertaining lower gastrointestinal manifestations in MUTYH-associated polyposis

Statements	Level of evidence and agreement
MAP.LGM.1: Lower-GI tract surveillance is recommended in individuals with biallelic MUTYH pathogenic variants.	LE: Low Agreement: 100% (SA 55%; A: 45%)
MAP.LGM.2: Colonoscopy surveillance, in the absence of symptoms, should generally start at the age of 18 years, but exceptionally may be started earlier, based upon family history.	LE: Low Agreement: 90% (SA 38%; A: 52%; N: 7%; D: 3%)
MAP.LGM.3: The surveillance interval should be 1–2 yearly but may be personalized according to phenotype (polyp burden).	LE: Low Agreement: 97% (SA 47%; A: 50%; D: 3%)
MAP.LGM.4A: Most MAP patients present with an a-FAP-like colorectal polyposis. For these patients, endoscopic resection of colorectal adenomas may be preferred over surgery.	LE: Low Agreement: 86% (SA 32%; A: 54%; N: 11%; D: 3%)
MAP.LGM.4B: If surgery is considered, it should be discussed in a multidisciplinary setting. The discussion must consider the polyp burden (colonic and rectal), age, co-morbidities, and the patient’s views, as well as their compliance with endoscopic surveillance.	LE: Low Agreement: 93% (SA 48%; A: 45%; N: 7%)
MAP.LGM.4C: The type of surgery depends on the rectal polyp burden. Consider colectomy with IRA as the first option. If there is dense rectal polyposis that cannot be managed endoscopically, consider proctocolectomy with IPAA.	LE: Low Agreement: 97% (SA 55%; A: 42%; N: 3%)
MAP.LGM.4D: Prophylactic surgery is not recommended in patients with pathogenic variants in MUTYH who have not developed colorectal polyps or cancer.	LE: Low Agreement: 96% (SA 57%; A: 39%; D: 4%)
MAP.LGM.5: MAP patients may benefit from a total colectomy instead of a segmental colectomy when they present with or without confirmed colorectal cancer. However, patients who have received thorough counselling may choose to undergo a segmental colectomy instead.	LE: Low Agreement: 92% (SA 38%; A: 54%; N: 8%)
MAP.LGM.6A: Lower-GI tract surveillance is recommended in MAP patients. The surveillance interval should be 1–2 yearly but may be personalized according to phenotype.	LE: Low Agreement: 100% (SA 53%; A: 47%)
MAP.LGM.6B: In patients having proctocolectomy with IPAA, endoscopic surveillance of the pouch is recommended post-surgery.	LE: Low Agreement: 97% (SA 55%; A: 42%; N: 3%)

A, agree; a-FAP, attenuated familial adenomatous polyposis; D, disagree; FAP, familial adenomatous polyposis; GI, gastrointestinal; IPAA, ileal pouch anal anastomosis; IRA, ileorectal anastomosis; LE, level of evidence; MAP, MUTYH-associated polyposis; N, neutral; SA, strongly agree; SD, strongly disagree.