13. Appropriateness of Colonoscopy: Surveillance After Curative Resection of Colorectal Cancer 1

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Abstract
Almost all cancers of the colon and rectum are carcinomas that develop from the mucosal epithelium. Cancer of the colon and of the rectum are generally considered together under the heading of colorectal cancers. Most of these cancers are adenocarcinomas, and the development of carcinoma from an adenomatous polyp is considered to be the most common developmental feature of colorectal cancer. Patients with previous adenomatous polyps or colorectal cancer have an increased risk of developing a further cancer. In Europe, the annual age-standardized incidence (world population) of colorectal cancer is between 20 and 45 per 100 000 among males and between 15 and 30 per 100 000 among females [ 1 ]. Incidence rates increase in a regular fashion with age [ 1 ] [ 2 ] [ 3 ] . Surveillance monitors people with previously diagnosed colorectal disease: patients who have had polyps (described in a separate article in this issue of the Journal [ 4 ]), inflammatory bowel disease (described in a joint article in this issue of the Journal [ 5 ]) and colorectal cancer (described in this article) [ 6 ]. In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [ 7 ], and of the whole process, as well as the global results of the panel [ 8 ], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing. This article contains three parts; 1. the review of the literature that was used by the panelists to support their ratings of appropriateness of use of colonoscopic surveillance after curative intent resection of colorectal cancer; 2. an overview of the main panel results; 3. a summary of the published evidence and of the panel based appropriateness criteria. 1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

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