What are the characteristics of high-risk patients for colonoscopy?

From the Guidelines

High-risk patients for colonoscopy include those with a history of polyps at prior colonoscopy, colorectal cancer, or a family history of colorectal cancer or adenomatous polyps, as outlined in the guidelines by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology 1.

Characteristics of High-Risk Patients

The characteristics of high-risk patients for colonoscopy can be broken down into several categories, including:

• Increased risk due to a history of polyps at prior colonoscopy, such as patients with 3 to 10 adenomas, or 1 adenoma 1 cm, or any adenoma with villous features or high-grade dysplasia 1
• Increased risk due to a history of colorectal cancer, such as patients with colon and rectal cancer who should undergo colonoscopy 3 to 6 months after cancer resection 1
• Increased risk due to a family history of colorectal cancer or adenomatous polyps, such as patients with a first-degree relative with colorectal cancer or adenomatous polyps before age 60 years or in 2 or more first-degree relatives at any age 1

Recommendations for High-Risk Patients

The recommended screening and surveillance intervals for high-risk patients vary depending on their individual risk factors, but generally include colonoscopy at intervals of 3 to 5 years 1. Some key recommendations for high-risk patients include:

• Patients with a history of polyps at prior colonoscopy should undergo colonoscopy at intervals of 3 to 5 years, depending on the number and type of polyps found 1
• Patients with a history of colorectal cancer should undergo colonoscopy 3 to 6 months after cancer resection, and then at intervals of 1 to 3 years 1
• Patients with a family history of colorectal cancer or adenomatous polyps should undergo colonoscopy starting at age 40 years, or 10 years before the youngest case in the immediate family, and then at intervals of 5 years 1

From the Research

Characteristics of High-Risk Patients for Colonoscopy

• High-risk groups for colonoscopy include patients with a history of colorectal cancer, adenomas, or dysplasia, as well as those with inherited bleeding disorders such as haemophilia A and B, von Willebrand disease, factor VII deficiency, and factor XI deficiency 2, 3
• Patients taking aspirin or other anticoagulants may also be considered high-risk for colonoscopy, although the risk of postpolypectomy bleeding is low and guidelines suggest that aspirin can be continued in most cases 4
• Patients with acute lower gastrointestinal bleeding (LGIB) may require urgent colonoscopy, but the timing of the procedure does not appear to affect outcomes such as further bleeding or mortality 5
• Patients with congenital bleeding disorders can undergo gastrointestinal endoscopy with a low risk of bleeding when properly managed by a team experienced in bleeding disorders 3

Risk Factors for Bleeding During Colonoscopy

• Inherited bleeding disorders such as haemophilia A and B, von Willebrand disease, factor VII deficiency, and factor XI deficiency 3
• Use of anticoagulants such as aspirin, although the risk is low and guidelines suggest that aspirin can be continued in most cases 4
• History of colorectal cancer, adenomas, or dysplasia 2
• Presence of vascular abnormalities or other conditions that may increase the risk of bleeding during colonoscopy 6

Management of High-Risk Patients for Colonoscopy

• Proper risk stratification and patient counseling are essential for managing high-risk patients for colonoscopy 2
• Use of prophylactic treatments such as plasma-derived factor, recombinant factor, desmopressin, and/or tranexamic acid may be necessary for patients with inherited bleeding disorders 3
• Close monitoring and follow-up are necessary to minimize the risk of bleeding and other complications during and after colonoscopy 4, 3