Description

Mid-Level Flow Diagram

Most recent CRCscreening test iscolonoscopy?Recommendation: Patient should beunder colonoscopy surveillanceEndoscopistrecommendedinterval in mostrecent colonoscopy?Recommendation: Next due date perendoscopist-recommended intervalRecommendation: Follow-up withendoscopistyesnoyesno

Semi-Structured Logic Statements

Inclusions

NameDescription
Personal history of potentially precancerous polyp(s)
History of conventional adenoma or serrated lesion (sessile serrated polyp or traditional serrated adenoma)
CONDITIONS include `History of potentially precancerous polyps`
OR
'Finding(s) of potentially precancerous polyp(s)' associated with any previous 'Colonoscopy' exists

Exclusions

None.

Events

NameDescription
Most recent CRC screening test is colonoscopy?
Endoscopist recommended interval in most recent colonoscopy?
The interval recommended by the endoscopist for the next screening or surveillance colonoscopy.
'Recommended follow-up interval' associated with latest 'Colonoscopy' exists

Actions

Recommendation: Patient should be under colonoscopy surveillance
Description
Recommendation: Patient is at increased risk due to a history of potentially precancerous polyp(s). Colonoscopy surveillance is recommended.
Pseudocode
Recommendation: Next due date per endoscopist-recommended interval
Description
Recommendation: Follow endoscopist-recommended interval.

Considerations:
* Interval may be shorter than 10 years even if most recent colonoscopy is normal (e.g. when a patient had advanced adenoma(s) in baseline colonoscopy).
Pseudocode
Next due date = DATE of latest 'Colonoscopy' date + 'Recommended follow-up interval' associated with latest 'Colonoscopy'
Recommendation: Follow-up with endoscopist
Description
Recommendation: Follow-up with endoscopist to determine appropriate interval for next colonoscopy.

Considerations:
* Interval may be shorter than 10 years even if most recent colonoscopy is normal (e.g. when a patient had advanced adenoma(s) in baseline colonoscopy).
Pseudocode

References

  • USMSTF (2020): Gupta, S., et al. (2020). Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointestinal Endoscopy, Gastroenterology, The American Journal of Gastroenterology, 91(3), 463-485.e5. https://doi.org/10.1016/j.gie.2020.01.014

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