No of points | 1 | 2 | 3 |
No of polyps | 1–4 | 5–20 | >20 |
Polyp size (mm) | 1–4 | 5–10 | >10 |
Histology | Tubulous | Tubulovillous | Villous |
Dysplasia | Mild | Moderate | Severe |
Points | Stage | Surveillance endoscopy |
0 | 0 | 5 years |
1–4 | I | 5 years |
5–6 | II | 3 years |
7–8 | III | 1 year (±endoscopic therapy BSG only) |
9–12 | IV | 6 months (ESGE)—6–12 months (BSG)±endoscopy or surgery |
Ampulla | Assessment | Minimum interval adjustment if longer with Spigelman score |
Normal | Normal | 5 years |
Minor | <1 cm, tubular, LGD | 3 years |
Major | >1 cm, villious or HGD | 1 year or consideration of ampullectomy |
Initial biopsy histology can be used for histology score, with adjustment for earlier surveillance interval if minor or major ampullary adenoma detected (see also figure 2)37 38 40
BSG, British Society of Gastroenterology; ESGE, European Society of Gastrointestinal Endoscopy; HGD, high-grade dysplasia; LGD, low grade dysplasia.