Get the free Polyp Surveillance Data Collection Form - gastro

This form is designed for collecting data on patients who have undergone a colonoscopy with the removal of polyps. It captures patient eligibility, colonoscopy report details, polyp findings, pathology

How to fill out polyp surveillance data collection

How to fill out Polyp Surveillance Data Collection Form

1. Obtain the Polyp Surveillance Data Collection Form from your healthcare provider or institution.
2. Begin with the patient identification section: fill out the patient's name, date of birth, and medical record number.
3. Document the date of the colonoscopy that led to polyp detection.
4. Record the type and number of polyps found during the procedure.
5. Indicate the size of each polyp and their histological findings (e.g., adenomatous, hyperplastic).
6. Fill in the details regarding the recommendation for surveillance intervals based on the findings.
7. Review all entries to ensure accuracy and completeness.
8. Sign and date the form before submission to the appropriate department or personnel.

Who needs Polyp Surveillance Data Collection Form?

1. Healthcare providers managing patients with a history of polyps.
2. Colorectal specialists who require information for tracking patient outcomes.
3. Research organizations that analyze polyp data for studies.
4. Hospitals and clinics that comply with polyp surveillance guidelines.

People Also Ask about

Do inflammatory colon polyps need surveillance?

Following the finding and removal of colonic polyps at an initial colonoscopy, some patients are at an increased risk of developing CRC in the future. This is the rationale for post-polypectomy surveillance colonoscopy.

When should you stop colon polyp surveillance?

People over age 85 should no longer get colorectal cancer screening. *For screening, people are considered to be at average risk if they do not have: A personal history of colorectal cancer or certain types of polyps. A family history of colorectal cancer.

What are the surveillance guidelines for polyps?

The BSG/ACPGBI/PHE recommends surveillance after 3 years in the presence of 2 or more precancerous polyps. The BSG/ACPGBI/PHE recommends checking the site once more 18 months after the original excision. The JGES proposes surveillance intervals of 3–5 years for SSL without considering size and number.

What are the nice guidelines for surveillance colonoscopy?

Surveillance can be stratified by risk: • low: consider colonoscopy at 5 years, • intermediate: offer colonoscopy at 3 years, • high: offer colonoscopy at 1 year. Other tests, e.g. computed tomographic colonography (CTC) or double contrast barium enema, should be offered if indicated.

Do inflammatory polyps need to be removed?

Over time, small polyps can change their structure and become cancerous. Polyps are usually removed when they are found on colonoscopy, which reduces the chance for that polyp to become cancerous.

What is the difference between surveillance and screening colonoscopy?

Diagnostic colonoscopies, also referred to as follow-up or surveillance colonoscopies, are different from screening colonoscopies since such procedures are provided when there is a greater probability of cancer development or if there is evidence that colorectal cancer might be present.

Are inflammatory polyps precancerous?

Inflammatory polyps are benign and generally do not carry the risk of developing into colon cancer.

How often should I have an endoscopy if polyps are found?

11. For patients with 1-2 sessile serrated polyps (SSPs) <10 mm in size completely removed at high-quality examination, repeat colonoscopy in 5-10 years. 12. For patients with traditional serrated adenomas (TSAs) completely removed at a high-quality examination, repeat colonoscopy in 3 years.

How common are inflammatory polyps?

Introduction. Inflammatory polyps occur in 10%–20% of patients with inflammatory disease (IBD).

How often should colon polyps be checked?

If there are 5 or more small or 3 or more larger polyps, then follow-up in one year is recommended. Findings on subsequent colonoscopies will determine the next follow-up interval; in general, the time between colonoscopies may be increased if fewer or no polyps are found.

For pdfFiller’s FAQs

What is Polyp Surveillance Data Collection Form?

The Polyp Surveillance Data Collection Form is a standardized document used to gather and report data related to the surveillance and management of colorectal polyps.

Who is required to file Polyp Surveillance Data Collection Form?

Healthcare providers and facilities involved in the diagnosis and treatment of colorectal polyps are typically required to file the Polyp Surveillance Data Collection Form.

How to fill out Polyp Surveillance Data Collection Form?

To fill out the Polyp Surveillance Data Collection Form, gather relevant patient information, document the type and characteristics of the polyps, provide any follow-up recommendations, and ensure all necessary fields are completed accurately.

What is the purpose of Polyp Surveillance Data Collection Form?

The purpose of the Polyp Surveillance Data Collection Form is to facilitate the collection of data for monitoring patient outcomes, improving clinical practices, and contributing to colorectal cancer research and prevention efforts.

What information must be reported on Polyp Surveillance Data Collection Form?

Information that must be reported includes patient demographics, polyp characteristics, procedures performed, follow-up recommendations, and outcomes of any interventions.