What is the recommended surveillance interval for a patient with a sessile serrated adenoma (SSA) found during a screening colonoscopy (colonoscopy)?

From the Guidelines

The recommended surveillance interval for a patient with a sessile serrated adenoma (SSA) found during a screening colonoscopy is typically 3 years, considering the patient has an 8-mm sessile serrated adenoma from the transverse colon.

Key Considerations

• The size of the SSA is 8mm, which is close to the 10mm threshold that often prompts a shorter surveillance interval.
• The presence of an SSA, regardless of size, indicates a need for careful surveillance due to its potential for malignant transformation through the serrated neoplasia pathway.
• The patient also has a 7-mm tubular adenoma from the cecum and a 2-mm hyperplastic polyp from the sigmoid colon, but the primary concern for surveillance interval determination in this context is the SSA.

Surveillance Interval Determination

• According to the most recent guidelines, patients with sessile serrated lesions that appear associated with a higher risk of future neoplasia or colorectal cancer (such as those ≥10 mm or with dysplasia) should be considered for a shorter surveillance interval 1.
• Given the size of the SSA (8mm) and its location, a 3-year surveillance interval is prudent, aligning with recommendations for lesions that may have a higher risk profile but do not meet the exact criteria for the highest risk category 1.

Clinical Judgment and Patient Factors

• The decision on the surveillance interval should also consider other clinical factors, including the patient's overall health, family history of colorectal cancer, and the completeness of polyp removal 1.
• However, based on the information provided, the primary factor influencing the surveillance recommendation is the presence and characteristics of the SSA.

Conclusion Not Applicable - Direct Answer Only

The patient's surveillance recommendation should fall into the 3-year interval category, prioritizing early detection and management of potential future neoplasia given the presence of an SSA.

From the Research

Surveillance Interval Recommendation

The patient in question has undergone a screening colonoscopy with excellent bowel prep and had 3 polyps removed: a 7-mm tubular adenoma from the cecum, an 8-mm sessile serrated adenoma from the transverse colon, and a 2-mm hyperplastic polyp from the sigmoid colon.

• The USMSTF guidelines recommend surveillance intervals based on the type and size of polyps found during colonoscopy 2.
• For patients with one or two tubular adenomas smaller than 10 mm, a repeat colonoscopy is recommended in 5 to 10 years.
• However, patients with a sessile serrated adenoma, regardless of size, are recommended to have a repeat colonoscopy in 5 years if the polyp is nondysplastic and smaller than 10 mm.
• Given that the patient has a sessile serrated adenoma, the recommended surveillance interval would be 5 years, but since the patient also has other polyps, including a tubular adenoma, the overall recommendation would be based on the most advanced lesion found.
• According to the guidelines, patients with a sessile serrated polyp that is smaller than 10 mm should have a repeat colonoscopy in 5 years 2.
• Therefore, based on the provided information, the patient's surveillance recommendation should fall into the 5-year interval.

Relevant Guidelines

• The USMSTF guidelines provide recommendations for surveillance intervals based on the findings of colonoscopy, including the type and size of polyps found 2, 3.
• These guidelines aim to promote the appropriate use of colonoscopy resources and reduce harms from delayed or unnecessary procedures.
• The guidelines also highlight the importance of considering the type and size of polyps when determining the surveillance interval.

Polyp Types and Surveillance

• Sessile serrated adenomas have malignant potential and warrant early surveillance colonoscopy 2, 4, 5.
• The detection rate of sessile serrated adenomas is significant, and their removal may help prevent interval colorectal carcinoma 4, 5.
• The guidelines recommend a repeat colonoscopy in 5 years for patients with nondysplastic serrated polyps that are smaller than 10 mm 2.