From the Guidelines
For a patient with a small, benign tubular adenoma without dysplasia who is taking hydrochlorothiazide for hypertension, the recommended surveillance interval is 10 years for a repeat colonoscopy. This recommendation is based on the most recent and highest quality study available, which suggests that patients with 1-2 small adenomas are not at significantly elevated risk of CRC compared with the general population 1. The study published in 2021 in the journal Gastroenterology provides evidence that assigning a 10-year follow-up interval for this group is appropriate, as they have a very low risk of future neoplasia 1.
Key Considerations
- The patient's hydrochlorothiazide medication for hypertension does not affect this surveillance recommendation, as it has no known impact on adenoma recurrence or progression.
- The extended interval is appropriate because small tubular adenomas without dysplasia have a very low risk of progressing to advanced neoplasia or colorectal cancer within this timeframe.
- However, if the patient has additional risk factors such as a family history of colorectal cancer, inflammatory bowel disease, or genetic syndromes, more frequent surveillance may be warranted.
- It's also important for the patient to continue regular primary care visits for blood pressure monitoring while on hydrochlorothiazide, but this is separate from the colonoscopy surveillance schedule.
Surveillance Interval
- The recommended surveillance interval of 10 years is based on the patient's low-risk findings, with only a single, 3-mm sessile polyp found and removed completely, and pathology confirming a tubular adenoma without dysplasia.
- This interval is consistent with the guidelines for colonoscopy surveillance after polypectomy, which recommend a follow-up interval of 10 years for patients with small colorectal hyperplastic polyps or 1-2 small tubular adenomas without high-grade dysplasia 1.
From the Research
Surveillance Colonoscopy Recommendations
The patient in question is a 53-year-old post-menopausal woman with hypertension, who has undergone an index screening colonoscopy procedure where a single, 3-mm sessile polyp was found and removed completely, with pathology confirming a tubular adenoma without dysplasia.
- The key factors to consider in determining the recommended surveillance interval for this patient include the type, size, and number of polyps found, as well as the patient's overall health and risk factors.
- According to the study 2, patients with one or two tubular adenomas that are smaller than 10 mm should have a repeat colonoscopy in five to 10 years.
- Given that the patient has a single, 3-mm tubular adenoma without dysplasia, the recommended surveillance interval would be in line with the guidelines for small, benign tubular adenomas.
- The study 3 also supports the idea that postpolypectomy colonoscopy intervals can be extended beyond 5 years in patients with nonadvanced adenomas, which would apply to this patient's case.
Recommended Surveillance Interval
Based on the evidence provided, the recommended surveillance interval for this patient would be:
- 5 to 10 years, as suggested by the study 2 for patients with one or two tubular adenomas smaller than 10 mm.
- This recommendation is also supported by the study 3, which found that patients with nonadvanced adenomas on index colonoscopy had a similar risk of advanced adenoma on follow-up colonoscopy at 5 years versus 6 to 10 years.
Answer to Question 1
The correct answer to Question 1 would be:
- B) 5 years or
- D) 10 years, as the recommended surveillance interval is between 5 to 10 years, but the exact timing within this range is not specified in the provided evidence. However, based on the information given and the guidelines, the most appropriate choice given the options would be to recommend the patient return for surveillance colonoscopy in 5 years, considering the small size and benign nature of the polyp, as well as the patient's age and health status.