Time sensitive managements in hepato-gastroenterology

Table 6 Risk factors for colorectal cancer and the recommended timing of screening

Clinical situation	Ref.	Recommended age/time for screening colonoscopy	Recommended age/time for screening gastroscopy
Lynch syndrome	Ladigan-Badura et al[128], 2021	Every 1-2 years beginning between ages 20 years and 25 years or 2-5 years before earliest CRC diagnosis in the family, whichever is earlier	Considered especially for those with family history of gastric cancer and those of Asian ancestry; every 3-5 years beginning between the ages 30 years and 35 years
FAP	Weiss et al[129], 2021	Yearly starting at age 10 and continuing until colectomy; post-colectomy rectal or ileal pouch colonoscopy every 1-2 years; for attenuated FAP, yearly screenings should begin by age 20	Upper endoscopy to examine the stomach and duodenum at 20 years to 25 years; screening may start earlier if a patient undergoes colectomy before this age; the endoscopy should adequately visualize the ampulla of Vater (use of the side viewing endoscope may be advised)
Peutz-Jeghers syndrome	Weiss et al[129], 2021	Once the diagnosis is confirmed, regular surveillance and imaging are essential due to the increased malignancy risk; upper gastrointestinal endoscopy, video capsule endoscopy, and colonoscopy are recommended between ages 8 and 10 to screen for gastric, duodenal, and small bowel polyps; if polyps are detected on baseline screening, endoscopic evaluation should be repeated every 2 years to 3 years; if polyps are absent, screening should resume every 2 years to 3 years beginning at age 18
MUTYH-associated polyposis	Weiss et al[129], 2021	Colonoscopy with polypectomy every one to two years beginning at age 25-30 years; prophylactic colectomy when the polyps became unmanageable	Consider upper endoscopy (including side viewing duodenoscopy) exam at 30-35 years examination, which should evaluate the ampulla of Vater; repeat every three months to four years based on initial findings (number, size, and type of polyps found)
Juvenile polyposis syndrome	Shaheen et al[126], 2022	About 1-3 year interval range, start with symptoms or latest at 18-20 years
Hyperplastic polyposis		Every 1-2 years, prophylactic colectomy is performed when the polyps became unmanageable
Inflammatory bowel disease		See later
Post-endoscopic polypectomy		Depend on the size, morphology and histology of the polyp (Figure 2)
Post-surgical resection of CRC		In case of operated obstructive CRC where preoperative colonoscopy was not done, a colonoscopy should be carried out within 3-6 months after surgery; operated cases with pre-operative colonoscopy done should have colonoscopy at 1-year and 3-years from surgery, and once examination is unremarkable, revert to 5-year interval; if polyps are detected during colonoscopy the polyp surveillance intervals protocol should be followed

CRC: Colorectal cancer; FAP: Familial adenomatous polyposis; MUTYH: MutY DNA glycosylase.