The American Gastroenterological Association released a new clinical practice update on surveillance of metaplastic and premalignant conditions of the esophagus and colorectum in older adults, published Aug. 3 in Clinical Gastroenterology and Hepatology. Because surveillance colonoscopies and EGDs make up a significant share of GI case volume in the ASC setting, the update carries direct operational and clinical implications. Here are five things to know:
- The guidance targets when to stop surveillance, not just when to start. Prior AGA guidance focused mainly on defining high-risk populations, age of initiation and surveillance intervals. This update fills a gap around stopping criteria — an area lead author Audrey Calderwood, MD, director of the Comprehensive GI Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., said previously lacked detailed, practice-ready guidance.
- Surveillance decisions for patients older than 75 should be individualized, not automatic. The guidance states that continuing colorectal cancer screening or colorectal polyp surveillance in patients older than 75 should be based on an assessment of benefits, screening or polyp history, comorbidities and risks — not a blanket age cutoff.
- Documentation requirements are getting more specific. The guidance states that because colonoscopy carries a higher rate of adverse events with increasing age regardless of indication, the clinical decision-making process for colonoscopy in patients older than 75 should be clearly documented in the electronic health record. ASCs may want to review their charting workflows and consent processes for older surveillance patients accordingly.
- Barrett’s esophagus surveillance has a clear stop-rule. Per the guidance, inability to tolerate endoscopic therapy, surgery or oncologic intervention for esophageal adenocarcinoma should lead to cessation of Barrett’s esophagus surveillance regardless of a patient’s age.
- Shared decision-making tools are central to the update. For Barrett’s esophagus specifically, the guidance recommends using tools that predict dysplasia progression to help contextualize a patient’s cancer risk within their individual life expectancy, supporting more personalized conversations between GI physicians and older patients about whether continued surveillance makes sense.
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