From the Guidelines
Management and follow-up for patients with tubular adenomas, hyperplastic polyps, and polypoid colonic mucosa after hot biopsy forceps procedure should include surveillance colonoscopy in 3-5 years for low-risk findings (1-2 small tubular adenomas <10mm) or 3 years for higher-risk findings (3-10 adenomas, adenomas ≥10mm, or those with high-grade dysplasia). The patient's findings of multiple tubular adenomas in different parts of the colon, including the ileocecal valve, ascending colon, and transverse colon, as well as hyperplastic polyps and polypoid colonic mucosa, necessitate a tailored approach to management and follow-up. Key considerations include:
- The number and size of the adenomas: The patient has multiple adenomas, which increases the risk of colorectal cancer and necessitates closer surveillance.
- The location of the adenomas: Adenomas in the right colon may warrant closer surveillance due to the higher risk of malignancy.
- The presence of hyperplastic polyps: Hyperplastic polyps in the rectosigmoid are generally considered benign, but those in the right colon may require closer surveillance.
- The presence of polypoid colonic mucosa: This finding may require further evaluation to determine the underlying cause and appropriate management.
According to the most recent guidelines 1, the recommended interval for surveillance colonoscopy is:
- 7-10 years for 1-2 tubular adenomas <10mm
- 3-5 years for 3-4 tubular adenomas <10mm
- 3 years for 5-10 tubular adenomas <10mm, adenomas ≥10mm, or those with high-grade dysplasia
- 1 year for >10 adenomas on a single examination
Post-procedure care includes:
- Resuming normal diet
- Avoiding strenuous activity for 24 hours
- Watching for signs of complications such as severe abdominal pain, significant bleeding, or fever Patients should be educated about the importance of adherence to surveillance intervals, as polyp removal interrupts the adenoma-carcinoma sequence, significantly reducing colorectal cancer risk. Complete removal of all polyps is essential, as incomplete resection may lead to recurrence or progression to malignancy, particularly for adenomatous polyps which have malignant potential.
From the Research
Management and Follow-up Recommendations
The patient has been diagnosed with tubular adenomas, hyperplastic polyps, and polypoid colonic mucosa after a hot biopsy forceps procedure. The management and follow-up recommendations for this patient are as follows:
- For tubular adenomas, the recommendations include:
- Removal of the polyps through polypectomy, as seen in the case of adenomatous polyps of the ileocecal valve 2
- Follow-up colonoscopy to monitor for any new or recurrent polyps
- For hyperplastic polyps, the recommendations include:
- No specific treatment is required, as hyperplastic polyps are generally considered to be non-neoplastic
- Follow-up colonoscopy to monitor for any new or recurrent polyps
- For polypoid colonic mucosa, the recommendations include:
- Biopsy to rule out any malignant changes
- Follow-up colonoscopy to monitor for any new or recurrent lesions
Role of Microbiome in Colorectal Cancer
Recent studies have shown that the gut microbiome plays a key role in the development of colorectal cancer, including the adenoma-carcinoma sequence and the serrated pathway 3. The study found that the microbiomes of individuals with tubular adenomas and serrated polyps were significantly different from each other and from polyp-free individuals. This suggests that the microbiome may be an important factor in the development and progression of colorectal cancer.
Individualized Management
The exact management of the patient's condition will depend on various factors, including the size and location of the polyps, the patient's overall health, and the presence of any symptoms. As stated in the study on adenomatous polyps of the ileocecal valve, the management is individualized and may include simple polypectomy, segmental resection, or even subtotal colectomy 2.