Recommended endoscopic follow-up or surveillance intervals

Jump to:

• Cancer associated lesions
• Pre-malignant lesions
• Selected focal lesions
• Hereditary conditions and endoscopy surveillance
• Spigelman classification
• References

Cancer associated lesions

Lesion	Follow-up endoscopy
Oesophageal ulcer	6 weeks later with PPI treatment
Severe Oesophagitis (LA Grade D)	6 weeks later with PPI treatment
Gastric ulcer	6-8 weeks later with testing for H.pylori and PPI treatment

Pre-malignant lesions

Barrett’s oesophagus

Barrett’s parameters	Surveillance interval
Maximal length over 3cm	2-3 years
Maximal length less than 3cm with intestinal metaplasia	3-5 years
Maximal length less than 3cm with only gastric metaplasia on index endoscopy	Repeat endoscopy interval dependent on confidence in the diagnosis
Maximal length less than 3cm with gastric metaplasia on repeat endoscopy	Discharge

Barrett’s oesophagus with dysplasia

Type of dysplasia	Management
Indefinite for dysplasia	Repeat endoscopy in 6 months on maximal acid suppression
Low grade dysplasia	Endoscopy every 6 months until two consecutive endoscopies with no evidence of dysplasia
High grade dysplasia	MDT discussion, review by two pathologists and intervention, usually endoscopic resection, if appropriate to patient

Chronic atrophic gastritis

Distribution	Surveillance interval
Incisura and antrum	Not required
Involving the body/corpus	Every 3 years

Non-visible gastric dysplasia

Type of dysplasia	Surveillance interval
Non-visible low-grade dysplasia	Annual endoscopy and if no dysplasia for three consecutive endoscopies, step down to 3 yearly
Non-visible high-grade dysplasia	6 monthly endoscopies

Visible gastric dysplasia

Type of dysplasia	Management
Visible high- or low-grade dysplasia	Offer endoscopic resection followed by annual surveillance if appropriate to patient

Adenomas

Type	Management
Gastric adenoma	Offer endoscopic resection if appropriate followed by annual surveillance endoscopy
Duodenal adenoma	Offer resection if appropriate with repeat endoscopy at 3 months for site check

Selected focal lesions

Gastric polyps

Type	Management
Hyperplasic polyp	Treat H. pylori if positive and if >1cm, pedunculated polyp morphology or symptomatic polyp, offer resection. Patients should be screened for atrophic gastritis and gastric dysplasia.
Fundic gland polyp	If over 20 polyps in a patient under 40 with dysplasia or duodenal adenoma consider FAP (see below).

Hereditary conditions and endoscopy surveillance

Condition	Surveillance guideline
Familial adenomatous polyposis (FAP)	Beginning at aged 25 as per Spigelman classification (see below)
MUTYH-associated polyposis (MAP)	Beginning at aged 35 as per Spigelman classification (see below)
Juvenile polyposis syndrome (JPS) SMAD4 pathogenic variant carriers	Beginning at age 18 endoscopies 1–3 yearly depending on phenotype
Juvenile polyposis syndrome (JPS) BMPR1A pathogenic variant carriers	Beginning at age 25 endoscopies 1–3 yearly depending on phenotype
Peutz-Jeghers syndrome (PJS)	Should begin at aged 8. If index endoscopy is normal can be repeated at aged 18. If polyps found, endoscopy should be repeated 3 yearly

Spigelman classification

Points allocated	1	2	3
Number of polyps	1–4	5–20	>20
Polyp size (mm)	1–4	5–10	>10
Histological type	Tubular	Tubulovillous	Villous
Degree of dysplasia	Mild	Moderate	Severe

Total points	Spigelman stage	Recommended follow-up interval
0	0	5 yearly endoscopy
1-4	I	5 yearly endoscopy
5-6	II	3 yearly endoscopy
7-8	III	Annual and consider endoscopic therapy
9-12	IV	6–12 months and consider endoscopic or surgical therapy

References

The following references contain further details:

1. Beg S, Ragunath K, Wyman A, Banks M, Trudgill N, Pritchard DM, Riley S, Anderson J, Griffiths H, Bhandari P, Kaye P, Veitch A. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut. 2017 Nov;66(11):1886-1899. doi: 10.1136/gutjnl-2017-314109. Epub 2017 Aug 18. Erratum in: Gut. 2017 Dec;66(12 ):2188. PMID: 28821598; PMCID: PMC5739858.
2. Banks M, Graham D, Jansen M, Gotoda T, Coda S, di Pietro M, Uedo N, Bhandari P, Pritchard DM, Kuipers EJ, Rodriguez-Justo M, Novelli MR, Ragunath K, Shepherd N, Dinis-Ribeiro M. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. 2019 Sep;68(9):1545-1575. doi: 10.1136/gutjnl-2018-318126. Epub 2019 Jul 5. PMID: 31278206; PMCID: PMC6709778.
3. Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, O’Donovan M, Bird-Lieberman E, Bhandari P, Jankowski JA, Attwood S, Parsons SL, Loft D, Lagergren J, Moayyedi P, Lyratzopoulos G, de Caestecker J; British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014 Jan;63(1):7-42. doi: 10.1136/gutjnl-2013-305372. Epub 2013 Oct 28. PMID: 24165758.
4. Vanbiervliet G, Moss A, Arvanitakis M, Arnelo U, Beyna T, Busch O, Deprez PH, Kunovsky L, Larghi A, Manes G, Napoleon B, Nalankilli K, Nayar M, Pérez-Cuadrado-Robles E, Seewald S, Strijker M, Barthet M, van Hooft JE. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021 May;53(5):522-534. doi: 10.1055/a-1442-2395. Epub 2021 Apr 1. PMID: 33822331.
5. Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, Ilyas M, Kaur A, Lalloo F, Latchford A, Rutter MD, Tomlinson I, Thomas HJW, Hill J; Hereditary CRC guidelines eDelphi consensus group. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut. 2020 Mar;69(3):411-444. doi: 10.1136/gutjnl-2019-319915. Epub 2019 Nov 28. PMID: 31780574; PMCID: PMC7034349.