When is the next colonoscopy due for a patient with a history of traditional serrated adenomas (TSAs), numerous serrated adenomas (SAs) with or without dysplasia, regular adenomas, three tubular adenomas (TAs) 5-9 mm in size in the transverse colon, a sessile serrated polyp with dysplasia 8 mm in size in the sigmoid colon, three hyperplastic polyps (HPs) less than 3 mm in size in the rectum, a 15 mm tubular adenoma in the ascending colon, and a 3 cm sessile tubular adenoma in the transverse colon?

From the Guidelines

You should have your next colonoscopy in 1 year. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of surveillance intervals in patients with high-risk findings, such as those present in your case 1. The presence of a sessile serrated polyp with dysplasia in the sigmoid colon, multiple tubular adenomas (including a 3 cm sessile TA in the transverse colon), and traditional serrated adenomas significantly increases your risk for developing colorectal cancer.

The guidelines from the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance recommend one-off surveillance colonoscopy at 3 years for patients with an advanced serrated polyp, but your case involves multiple high-risk lesions, necessitating a shorter surveillance interval 1. The study also suggests that the future CRC risk may be additive between serrated and adenomatous polyps, and their numbers should be summated when determining surveillance intervals.

Key factors influencing this recommendation include:

• The size and type of polyps found, including the 3 cm sessile TA in the transverse colon and the sessile serrated polyp with dysplasia in the sigmoid colon
• The presence of multiple serrated lesions, including those with dysplasia
• The potential for incomplete removal and recurrence of large adenomas
• The tendency toward polyp formation across different segments of the colon

After your 1-year follow-up colonoscopy, if no high-risk findings are detected, the interval may be extended, but this will depend on the findings at that time. It's essential to maintain this surveillance schedule as recommended to prevent the development of colorectal cancer. The earlier guidelines from the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society also support the concept of risk stratification and individualized surveillance intervals, but the more recent study provides a stronger basis for the recommended 1-year interval 1.

From the Research

Determining the Next Colonoscopy

Given the patient's history of traditional serrated, numerous sessile serrated adenomas (SSAs) with dysplasia or not, regular adenomas, and other polyps, the timing of the next colonoscopy can be determined based on the following factors:

• The size and type of polyps removed
• The presence of dysplasia
• The location of the polyps

Risk Factors and Surveillance Intervals

According to the studies 2, 3, 4, 5, 6, the risk of colorectal neoplasia after removal of conventional adenomas and serrated polyps is significant, and surveillance colonoscopy is recommended to prevent subsequent colorectal cancer. The optimal intervals for surveillance remain unclear, but the following factors can guide the determination of the next colonoscopy:

• Advanced adenomas and high-risk serrated polyps have a higher risk of CRC, with the highest risk observed at 3 years after polypectomy
• The use of surveillance colonoscopy is associated with lower risk of CRC
• Patients with high-risk polyp findings are at higher risk of subsequent CRC and high-risk polyps and may benefit from early surveillance within 3 years

Specific Considerations for This Patient

Based on the patient's history, the following considerations can be made:

• The presence of a sessile serrated polyp with dysplasia 8 mm in sigmoid and a tubular adenoma (TA) 15 mm in ascending colon indicate a high risk of CRC
• The presence of numerous SSAs with dysplasia or not also indicates a high risk of CRC
• The patient's history of regular adenomas and other polyps also contributes to the overall risk assessment

Recommendations for the Next Colonoscopy

Based on the studies and the patient's history, the next colonoscopy is recommended in:

• 3 years, given the high risk of CRC associated with the patient's polyp history and the presence of advanced adenomas and high-risk serrated polyps
• The surveillance interval may be adjusted based on the findings of the next colonoscopy and the patient's overall risk assessment

Key Points to Consider

• The patient's age, sex, and family history of colorectal cancer should be taken into account when determining the surveillance interval
• The use of surveillance colonoscopy should be guided by the US Multi-Society Task Force recommendations and individualized based on the patient's risk factors and polyp history
• Adherence to surveillance recommendations is crucial to prevent subsequent CRC and high-risk polyps.