From the Guidelines
For individuals with a personal history of adenomatous polyps, surveillance colonoscopy is recommended 3 years after the initial polypectomy, with the interval adjusted based on the number, size, and type of polyps found, as well as other clinical factors, such as family history and patient preferences, as outlined in the guidelines from the American Cancer Society and other organizations 1. The screening recommendations for patients with a personal history of colorectal polyps (adenomatous polyps) depend on several factors, including the type, number, and size of polyps found during previous colonoscopies.
- For low-risk findings, such as 1-2 small tubular adenomas with low-grade dysplasia, screening is recommended in 5-10 years after the initial polypectomy, with the precise timing based on other clinical factors, such as prior colonoscopy findings, family history, and patient preferences 1.
- For high-risk findings, such as advanced adenomas, multiple adenomas, or adenomas with high-grade dysplasia, more frequent surveillance at 3-year intervals is recommended, with the possibility of an underlying familial syndrome considered in patients with 10 or more adenomas on a single examination 1. The guidelines also emphasize the importance of individualizing surveillance intervals based on the endoscopist's judgment, taking into account factors such as completeness of polyp removal, patient preferences, and quality of bowel preparation during previous examinations 1. It is essential to follow the gastroenterologist's specific recommendations, as they may be tailored to the individual's risk factors, including family history, polyp characteristics, and other clinical factors, to ensure optimal detection and removal of precancerous lesions before they progress to cancer 1.
From the Research
Screening Recommendations for Patients with a Personal History of Colorectal Polyps
- Patients with a history of adenomatous polyps require follow-up surveillance colonoscopy at a four-year to five-year interval, as the risk of subsequent colonic neoplasms is not significantly reduced by a normal interim colonoscopy 2.
- The risk of recurrent advanced adenomas is higher in patients with > or =3 adenomas at index colonoscopy, and in those with adenomas with high-grade dysplasia at index colonoscopy 3.
- Current guidelines stratify patients with a personal history of adenomas as low risk (1-2 small adenomas at index colonoscopy) or high risk (> or =3 small adenomas or advanced adenoma at index colonoscopy) for recurrent advanced adenomas 3.
- Advanced adenomas confer an increased risk of colorectal neoplasia to the affected individual and their first-degree relatives, and professional guidelines suggest earlier and more intensive screening for these high-risk individuals 4.
- Older age at first screening colonoscopy is associated with an increased risk of colorectal adenomas and cancer, highlighting the need for guideline adherence for the prevention of CRC development 5.
Special Considerations
- Familial adenomatous polyposis (FAP) is a condition characterized by the development of many adenomatous colorectal polyps, and colonoscopy is recommended to start at age 10 to 12 years at intervals of 1 to 2 years 6.
- Endoscopic surveillance is critical after colectomy in patients with FAP, and screening with upper endoscopy and ampullary visualization is recommended to detect duodenal and gastric polyposis 6.