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. Author manuscript; available in PMC: 2021 Mar 1.
Published in final edited form as: Gastrointest Endosc. 2020 Feb 7;91(3):463–485.e5. doi: 10.1016/j.gie.2020.01.014

Appendix A.

PICO (Patient, Intervention, Comparison, Outcome) questions

Section 1: APPROACH TO SURVEILLANCE
Question Population Intervention Comparison Outcome
1. Is repeat colonoscopy at 10 years preferred to earlier surveillance in patients with normal colonoscopy?
 Patients with normal colonoscopy Colonoscopy at 10 years Colonoscopy in <10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
2. Is no repeat colonoscopy preferred to colonoscopy at 10 years or earlier in patients with normal colonoscopy? Patients with normal colonoscopy No colonoscopy Colonoscopy in ≤10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
3. Is surveillance preferred to no surveillance in patients with 1–2 small (<10 mm) non-advanced adenomas? Patients with 1–2 small (<10 mm) non-advanced adenomas Colonoscopy surveillance No surveillance a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
4. Is surveillance at 5 years preferred to surveillance at 10 years in patients with 1–2 small (<10 mm) non-advanced adenomas? Patients with 1–2 small (<10 mm) non-advanced adenomas Colonoscopy surveillance at 5 years Colonoscopy surveillance at 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
5. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with sessile serrated adenoma/polyp size ≥10 mm and/or with dysplasia ? Patients with sessile serrated adenoma/polyp size ≥10 mm and/or with dysplasia Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
6. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with sessile serrated adenoma/polyp size <10 mm with no dysplasia ? Patients with sessile serrated adenoma/polyp size <10 mm with no dysplasia Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
7. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with advanced adenoma? Patients with any advanced neoplasia advanced (defined as adenoma with ≥10 mm, villous histology, and/or high-grade dysplasia) Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
8. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with adenoma ≥10 mm in size? Patients with any adenoma ≥10 mm Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
9. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with adenoma containing high-grade dysplasia? Patients with adenoma containing high-grade dysplasia Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
10. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with adenoma containing villous histology? Patients with adenoma containing villous histology Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
11. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with any proximal adenoma <10 mm? Patients with any proximal adenoma <10 mm (proximal defined as proximal to descending colon or splenic flexure) Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
12. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with ≥3 adenomas all <10 mm? Patients with ≥3 tubular adenomas all <10 mm Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
13. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with 3–4 adenomas <10 mm in size? a) Patients with 3–4 adenomas <10 mm in size
 Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
14. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with 3–4 adenomas <6mm in size? a. Patients with 3–4 adenomas <6mm in size
 Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
15. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with 5–9 adenomas <10 mm in size? a) Patients with 5–9 adenomas <10 mm Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
16. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with 5–9 adenomas <6mm in size? a. Patients with 5–9 adenomas <6mm Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
17. is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with hyperplastic polyp ≥10 mm in size? Patients with any hyperplastic polyp ≥10 mm in size Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
18. is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with proximal hyperplastic polyp ≥10 mm in size? Patients with proximal hyperplastic polyp ≥10 mm Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
19. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with any proximal hyperplastic polyp? Patients with proximal hyperplastic polyp Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
20. is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with a prior history of advanced adenoma? Patients with a personal history of advanced adenoma, stratified by current finding (non-advanced, advanced adenoma, normal) Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
21. is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with a prior history of non-advanced adenoma? Patients with a personal history of adenoma, stratified by current finding (non-advanced, advanced adenoma, normal) Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
22. Is surveillance at less than 3 years preferred to surveillance at 3 years in patients with more than 10 non advanced adenomas? Patients with more than 10 non-advanced adenomas Colonoscopy surveillance in less than 3 years Colonoscopy surveillance at 3 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
23. Is surveillance at 3 years preferred to surveillance at 5 or 10 years in patients with high adenoma volume Patients with high vs. low adenoma volume Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 or 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
24. Is surveillance in 5 years preferred to surveillance in 10 years in patients with prior history of non advanced adenoma and follow up normal colonoscopy? Patients with baseline non advanced adenoma and normal colonoscopy at 1st surveillance Colonoscopy surveillance at 5 years Colonoscopy surveillance at 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
25. Is surveillance in 5 years preferred to surveillance in 10 years in patients with prior history of advanced adenoma and follow up normal colonoscopy? Patients with baseline advanced adenoma and normal colonoscopy at 1st surveillance Colonoscopy surveillance at 5 years Colonoscopy surveillance at 10 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
26. Is surveillance in 3 years preferred to surveillance in 5 years in patients with prior history of advanced adenoma and follow up advanced adenoma? Patients with baseline advanced adenoma and advanced adenoma colonoscopy at 1st surveillance Colonoscopy surveillance at 3 years Colonoscopy surveillance at 5 years a. Detection of adenoma, advanced adenoma, and/or CRC
b. Reduction CRC incidence
c. Reduction CRC mortality
SECTION 2: RISK FACTORS FOR ADENOMA, ADVANCED ADENOMA, AND CRC ON FOLLOW UP
1. Among patients with one or more colorectal polyps, does having one or more purported risk factors, compared with not having the risk factor confer increased risk for advanced neoplasia on follow up colonoscopy? Patients with a purported risk factor for advanced neoplasia on follow up:

  • Adenoma ≥10 mm

  • Sessile serrated polyp ≥10 mm

  • Sessile serrated polyp with dysplasia

  • Adenoma high-grade dysplasia

  • Adenoma with villous histology

  • >2 non advanced adenomas

  • 3–4 non advanced adenomas

  • Sessile serrated adenoma/polyp without size ≥10 mm or high-grade dysplasia

  • Proximal adenoma

  • Proximal hyperplastic polyp

  • Proximal Hyperplastic polyp ≥10 mm

  • Distal Hyperplastic polyp ≥10 mm

  • Prior history of advanced adenoma

  • Prior history of adenoma

  • Family history of colorectal cancer

  • Family history of polyp

  • Total adenoma volume

 Presence of risk factor Absence of risk factor Risk for adenoma, advanced adenoma, and/or CRC
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