What is the treatment for tubular adenoma of the colon?

From the Guidelines

The primary treatment for tubular adenoma of the colon is complete removal through colonoscopic polypectomy, as recommended by the most recent guidelines 1. During a colonoscopy, the gastroenterologist will use specialized tools to remove the adenoma entirely, which may include snare polypectomy for smaller adenomas or endoscopic mucosal resection for larger ones. After removal, the tissue is sent for pathological examination to confirm the diagnosis and assess for any signs of dysplasia or early cancer. Follow-up surveillance colonoscopies are essential, with timing based on the number, size, and histology of the adenomas found. Some key points to consider in the follow-up include:

• Patients with 1–2 tubular adenomas <10 mm in size should have a follow-up colonoscopy in 7-10 years 1
• Patients with 3–4 adenomas <10 mm in size may have a follow-up colonoscopy in 3–5 years 1
• Patients with more than 10 adenomas should have a follow-up colonoscopy in 1 year 1 This approach is necessary because tubular adenomas are precancerous lesions that can progress to colorectal cancer if left untreated. Complete removal interrupts this progression, effectively preventing cancer development. No medications are typically prescribed specifically for tubular adenomas, as physical removal is the definitive treatment. It's worth noting that the guidelines have been updated to provide more detailed recommendations for follow-up after removal of serrated polyps and to emphasize the importance of high-quality baseline examination 1.

From the Research

Treatment Options for Tubular Adenoma of the Colon

• The treatment for tubular adenoma of the colon can vary depending on the size and location of the adenoma, as well as the patient's overall health.
• For smaller adenomas, cold snare polypectomy (CSP) or cold endoscopic mucosal resection (C-EMR) may be used, as these methods have been shown to be effective and safe for removing non-pedunculated polyps of 10-19 mm in size 2.
• For larger adenomas, such as those ≥ 20 mm, endoscopic mucosal resection (EMR) or piecemeal cold snare polypectomy (p-CSP) may be used, as these methods have been shown to be effective for removing large sessile serrated lesions 3.
• In some cases, surgical resection may be necessary, such as for adenomas that are too large to be removed endoscopically or for those that have a high risk of malignancy, and a "tubular" colonic or rectal resection can be used to remove the adenoma while preserving the surrounding tissue 4.
• The choice of treatment will depend on the specific characteristics of the adenoma and the patient's individual needs, and should be made in consultation with a healthcare provider.

Considerations for Treatment

• The risk of adenoma recurrence is an important consideration when choosing a treatment method, and studies have shown that factors such as polyp size, histology, and patient demographics can influence the risk of recurrence 5.
• The risk of complications, such as bleeding and perforation, is also an important consideration, and studies have shown that p-CSP may be associated with a lower risk of these complications compared to EMR 3.
• The effectiveness of the treatment method in removing the adenoma and preventing recurrence is also an important consideration, and studies have shown that CSP, C-EMR, and p-CSP can be effective for removing non-pedunculated polyps and preventing recurrence 2, 3.