What is the recommended follow-up for a patient with a 5mm tubular adenoma in the ascending colon and a 5mm hyperplastic polyp in the sigmoid colon?

From the Guidelines

A follow-up colonoscopy is recommended in 5 years based on your findings. You have two polyps: a 5mm tubular adenoma in the ascending colon and a 5mm hyperplastic polyp in the sigmoid colon. The tubular adenoma is a precancerous lesion, though low-risk due to its small size and lack of advanced features. The hyperplastic polyp in the sigmoid colon is generally considered non-precancerous.

Key Considerations

• Since you have only one small tubular adenoma (less than 10mm) without advanced features like villous histology or high-grade dysplasia, you fall into the low-risk category for colorectal cancer 1.
• The presence of a small hyperplastic polyp does not significantly alter the risk profile in this context, as hyperplastic polyps are generally considered to have very low malignant potential 1.
• This recommendation assumes you have no other risk factors such as family history of colorectal cancer, genetic syndromes, or inflammatory bowel disease.
• If this was your first colonoscopy, maintaining this interval is appropriate, but if you have additional risk factors, your gastroenterologist might recommend a shorter surveillance interval.

Surveillance Guidelines

• For patients with one or two small (< 1 cm) tubular adenomas with only low-grade dysplasia, the next follow-up colonoscopy is recommended in five to 10 years 1.
• The precise timing within this interval should be based on other clinical factors, such as previous colonoscopy findings, family history, patient preferences, and the judgment of the physician 1.

From the Research

Polyp Characteristics

• Ascending colon: 2 polyps, tubular adenoma, 5mm
• Sigmoid colon: 5mm hyperplastic polyp

Recommended Follow-up

Based on the provided evidence, there is no direct recommendation for follow-up for the specific polyp characteristics mentioned. However, the studies suggest that:

• The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin may be associated with a reduced risk of adenomatous polyps 2, 3
• Narrow-band imaging can be used to differentiate between adenomas and hyperplastic polyps, and can be learned in a short teaching session 4

Considerations for Follow-up

• The risk of colorectal cancer associated with adenomatous polyps, and the potential benefits of NSAID use in reducing this risk 2, 3
• The importance of accurate diagnosis and differentiation between adenomas and hyperplastic polyps, using techniques such as narrow-band imaging 4