Polyp surveillance

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Potentially life threatening symptoms suggestive of:

      • acute upper GI tract bleeding

      • acute severe lower GI tract bleeding

      • oesophageal foreign bodies/food bolus

      • Acute Severe Colitis*

      • bowel obstruction

      • abdominal sepsis

    • Severe vomiting and/or diarrhoea with dehydration

    • Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services

    • Biliary sepsis (to be referred to a centre with ERCP service)

    * Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

    • temperature at presentation of > 37.8°C,
    • pulse rate at presentation of > 90 bpm,
    • haemoglobin at presentation of < 105 gm/l, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)

    • Refer to HealthPathways or local guidelines

    NHMRC Clinical Practice Guidelines (2019) recommended screening colonoscopy schedules for polyp surveillance

    Colonoscopic surveillance after polypectomy, Cancer Council Guidelines, Cancer Council Australia

    • No sooner than 5 years – If < 5 polyps (excluding diminutive rectosigmoid hyperplastic polyps) provided that all polyps not 'advanced' lesions (<10mm in size and no advanced histopathology - no high-grade dysplasia or villous change.
    • 3 yearly – If > 5 polyps (excluding diminutive rectosigmoid hyperplastic polyps) OR if one or more polyps are 'advanced' (≥10mm and/or histopathology (presence of high-grade dysplasia or villous change)
    • Annual – If 5 to 9 polyps (excluding diminutive rectosigmoid hyperplastic polyps) IF ANY ADVANCED CHANGES
    • <12 months – If required, a baseline colonoscopy may need to be repeated in cases of poor bowel preparation (immediate rescheduling), possible incomplete excision of a large polyp (often at 3 months) or the presence of multiple adenomas (≥10) to ensure complete clearance

    NB: The risk benefit of surveillance should be considered, taking into account, the age and comorbid health of the patient. PATIENTS OVER THE AGE OF 75YRS SHOULD HAVE THE RISK BENEFITS DISCUSSED. SURVEILLANCE IS GENERALLY NOT RECOMMENDED OVER 80YRS

    NB: patients with Familial Adenomatous Polyposis (FAP) and Lynch syndrome (HNPCC) need punctual surveillance due to the high-risk nature of these conditions.

    NB: If a patient who has been fully investigated 2 years prior to referral.  Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures

    Clinical resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • See 'other useful information for referring practitioners'
Category 2
(appointment within 90 calendar days)

  • See 'other useful information for referring practitioners'
  • Polyp surveillance in special circumstances (see other useful information for referring practitioners)
Category 3
(appointment within 365 calendar days)

  • See 'other useful information for referring practitioners'
  • Routine polyp surveillance (see other useful information for referring practitioners)

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Family or personal history of colorectal cancer
  • Relatives diagnosed with FAP
  • Relatives diagnosed with HNPCC
  • Previous endoscopic procedures (date, report and histology)

3. Additional referral information Useful for processing the referral

  • No additional information

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 21 September 2022

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