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Despite regular need for colonoscopy in patients with Crohn's disease (CD), the efficacy and tolerability of bowel preparation (BP) agents is rarely assessed in this population. Assessing BP quality with existing scales may be challenging in CD due to presence of inflammation, bowel resection, and strictures.To provide recommendations for assessing BP quality in clinical trials for CD using a modified Research and Development/University of California, Los Angeles appropriateness process.Based on systematic reviews and a literature search, 110 statements relating to BP quality assessment in CD were developed. A panel of 15 gastroenterologists rated the statements as appropriate, uncertain, or inappropriate using a 9-point Likert scale.Panelists considered it appropriate that central readers, either alone or with local assessment, score BP quality in clinical trials. Central readers should be trained on scoring BP quality and local endoscopists on performing high-quality video recording. Both endoscope insertion and withdrawal phases should be reviewed to score BP quality in each colonic segment and segments should align with endoscopic disease activity indices. The Harefield Cleansing Scale and the Boston Bowel Preparation Scale were considered appropriate. The final score should be calculated as the average of all visualized segments. Both total and worst segment scores should also be assessed.We developed a framework for assessing BP quality in patients with CD based on expert feedback. This framework could support the development or refinement of BP quality scales and the integration of BP quality assessment in future CD studies.

Lynch syndrome (LS) is an autosomal dominant hereditary cancer syndrome caused by pathogenic germline variants (PGV) in any of the 4 DNA mismatch repair (MMR) genes, MLH1, MSH2, MSH6, and PMS2, or deletions in EPCAM. LS leads to an increased risk of intestinal and extraintestinal cancers, of which colorectal and endometrial cancers are the most common. Individuals at risk for LS can be identified by using clinical criteria, prediction models, and universal tumor testing. Understanding each of these tools, including limitations and mimics of LS, is essential to the early identification of at-risk individuals.

PURPOSE OF REVIEW: The purpose of this chapter is to highlight current recommendations regarding colorectal cancer (CRC) screening and post-polypectomy surveillance colonoscopy in older adults and to review the available literature in order to help inform decision-making in this age group. RECENT FINDINGS: Age is a risk factor for CRC, however, older adults with a history of prior screening are at lower risk for CRC compared to those who have never been screened. Decision-making for CRC screening and post-polypectomy surveillance colonoscopy in older adults is complex and several factors including age, screening history, comorbidities, functional status, bowel preparation, prior experiences, preferences, and barriers need to be considered when weighing risks and benefits. Recent guidelines have started to incorporate life expectancy and prior screening history into their recommendations; however, how to incorporate these factors into actual clinical practice is less clear. SUMMARY: There are limited data on the relative benefits of screening and surveillance in older adults and therefore, at this time, decision-making should be individualized and incorporate patient preferences in addition to medical factors.

Colorectal cancer incidence and mortality have decreased in the United States in recent decades, largely through opportunistic screening. Although certain organizations have improved internal screening rates by implementing programmatic screening, most of the United States undergoes opportunistic screening. Much effort and resources have been expended comparing screening tests to determine the most effective; however, deeper analysis of the US population has revealed subsets of ethnicities may be grossly underscreened. The most effective screening test remains the test that is completed and adhered to, and a better question may concern the best method of discussing screening.

Familial adenomatous polyposis (FAP) is known for its association with development of hundreds to thousands of colorectal adenomas and colorectal cancer (CRC). After CRC, the second most common malignancy in FAP is duodenal adenocarcinoma. Over the last several decades, optimized colonoscopic surveillance and timely referral for prophylactic colectomy have reduced morbidity and mortality from CRC in FAP. However, as survival of patients with FAP continues to improve, management of upper gastrointestinal tract neoplasia is critically important. The purpose of this chapter is to discuss the approach to surveillance of gastric, duodenal, and ampullary polyps that arise in individuals with FAP, specifically focusing on clinical features, management, and chemoprevention.

Adenoma detection rate (ADR) and sessile serrated polyp detection rate (SSPDR) data in surveillance colonoscopy are limited. Our aim was to determine surveillance ADR and SSPDR and identify associated predictors. A retrospective review of subjects who underwent surveillance colonoscopy for adenoma and/or SSP at an academic center was performed. The following exclusion criteria were applied: prior colonoscopy ≤ 3 years, incomplete examination, or another indication for colonoscopy. Patient, endoscopist, and procedure characteristics were collected. Predictors were identified using multivariable logistic regression. Of 3807 colonoscopies, 2416 met inclusion criteria. Surveillance ADR was 49% and, SSPDR was 8%. Higher ADR was associated with: age per year (OR 1.03; 95% CI 1.02–1.04), male gender (OR 1.55; 95% CI 1.29–1.88), BMI per kg/m2 (OR 1.02; 95% CI 1.01–1.04), withdrawal time per minute (OR 1.09; 95% CI 1.07–1.10), and endoscopists’ screening ADR (OR 1.01; 95% CI 1.00–1.03). Years since training (OR 0.99; 95% CI 0.98–0.99) was associated with lower ADR. Family history of CRC (OR 1.58; 95% CI 1.02–2.27) and endoscopists’ screening ADR (OR 1.40; 95% CI 1.15–1.74) were associated with higher SSPDR. African-American race (OR 0.36; 95% CI 0.10–0.75) and diabetes (OR 0.41; 95% CI 0.21–0.76) were associated with lower SSPDR. For surveillance colonoscopy, nearly half of patients had an adenoma and one in twelve had an SSP. In addition to established factors, BMI, endoscopists’ screening ADR, and years since training were associated with ADR, whereas African-American race and diabetes were inversely associated with SSPDR. Further studies are needed prior to integrating surveillance ADR and SSPDR into quality metrics.