From the Guidelines
After excision of a 0.5 cm tubulovillous adenoma, a repeat colonoscopy should be performed in 5-10 years. This recommendation is based on the size and histology of the polyp, which places it in the low-risk adenoma category, as suggested by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society 1. The study found that patients with one or two adenomas, all less than 1 cm in size, with no high-grade dysplasia or villous features, are at lower risk for subsequent advanced adenomas.
Some key points to consider when determining the timing of repeat colonoscopy include:
- The size of the adenoma, with those less than 1 cm being considered lower risk
- The histology of the adenoma, with tubulovillous adenomas carrying a higher risk than tubular adenomas but lower risk than villous adenomas
- The completeness of polyp removal and quality of bowel preparation during the initial colonoscopy
- Family history of colorectal cancer and the presence of other polyps found during the procedure
According to the guidelines, patients with low-risk adenomas can wait 5 and possibly 10 years for repeat colonoscopy 1. However, if multiple adenomas were found or if there were any high-risk features such as high-grade dysplasia, a shorter surveillance interval of 3 years would be more appropriate. If the colonoscopy reveals no adenomas at the follow-up examination, subsequent colonoscopy can typically be extended to every 5-10 years.
From the Research
Repeat Colonoscopy Recommendations
- For patients with one or two tubular adenomas that are smaller than 10 mm, a repeat colonoscopy is recommended in 5 to 10 years 2.
- The European Society of Gastrointestinal Endoscopy (ESGE) recommends that patients with complete removal of 1-4 <10 mm adenomas with low-grade dysplasia, irrespective of villous components, or any serrated polyp <10 mm without dysplasia, do not require endoscopic surveillance and should be returned to screening 3.
- However, for patients with adenomas that have villous features, such as a 0.5 cm tubulovillous adenoma, surveillance colonoscopy is recommended after 3 years 2, 4.
- The US Multi-Society Task Force (USMSTF) defines adenomas with tubulovillous or villous histology as high-risk adenomas, and thus recommends surveillance colonoscopy after 3 years 4.
Surveillance Intervals
- The ESGE recommends surveillance colonoscopy after 3 years for patients with complete removal of at least 1 adenoma ≥10 mm or with high-grade dysplasia, or ≥5 adenomas, or any serrated polyp ≥10 mm or with dysplasia 3.
- For patients with 1-2 sessile serrated polyps (SSPs) <10 mm and those with 3-4 SSPs <10 mm, the USMSTF recommends surveillance colonoscopy after 5-10 and 3-5 years, respectively 4.
- A study found that most endoscopists complied with national guidelines and recommended repeat colonoscopy in 3 to 5 years for young patients with neoplastic polyp(s) but no strong family history 5.
Clinical Practice Patterns
- A survey of gastroenterologists found that 80% of respondents recommend a 10-year screening interval in average-risk patients after normal colonoscopy, and 67% recommend repeat colonoscopy in 5 years for a patient with a family history of colon cancer in a first-degree relative at age 64 6.