From the Guidelines
For patients with hyperplastic polyps, the next colonoscopy is recommended in 10 years, as they are considered to have normal colonoscopies. This recommendation is based on the guidelines for colonoscopy surveillance after polypectomy, as outlined in the study published in the American Family Physician in 2008 1. The study provides a table outlining the post-colorectal polypectomy surveillance recommendations, which includes the recommendation for patients with small colorectal hyperplastic polyps to have a follow-up colonoscopy in 10 years.
Key Considerations
- The recommendation applies to patients with small colorectal hyperplastic polyps, which are considered to have normal colonoscopies 1.
- An exception is made for patients with the hyperplastic polyposis syndrome, who are at increased risk for adenomas and colorectal cancer and require more intensive follow-up 1.
- Individual risk factors, such as family history of colorectal cancer or personal history of inflammatory bowel disease, may warrant more frequent surveillance, and the follow-up interval should be personalized based on the patient's complete clinical picture and the endoscopist's judgment.
Surveillance Recommendations
- Patients with one or two small (< 1 cm) tubular adenomas with only low-grade dysplasia should have a follow-up colonoscopy in five to 10 years 1.
- Patients with three to 10 adenomas, any adenoma ≥ 1 cm, or any adenoma with villous features or high-grade dysplasia should have a follow-up colonoscopy in three years 1.
- Patients with more than 10 adenomas at one examination should have a follow-up colonoscopy at a shorter interval (three years or less) established by clinical judgment 1.
From the Research
Recommended Timing for Next Colonoscopy
The recommended timing for the next colonoscopy in a patient with a hyperplastic polyp is as follows:
- A hyperplastic polyp found during proctosigmoidoscopy is not an indication for colonoscopy 2
- Patients with small serrated polyps (including hyperplastic polyps) may not require more intensive surveillance than patients without polyps, and the interval for follow-up can be increased to 5 years after one negative result of a 3-year examination 3
- There is no significant increase in risk of CRC in patients with small serrated polyps, including hyperplastic polyps, and therefore follow-up surveillance may not be indicated 3
Surveillance Intervals
Surveillance intervals after diagnosis of a precursor lesion, particularly for individuals with serrated polyps, vary widely, and lack sufficient supporting evidence 3
- The US Multi-Society Task Force recommends follow-up surveillance colonoscopy after polyp removal in the bowel, with intervals depending on the most severe findings 4
- Compliance with follow-up guidelines after high-risk colorectal polyp removal is poor, with inappropriate intervals often longer than recommended 5
Factors Affecting Surveillance
Factors affecting surveillance include:
- Demographic factors, such as older age and lower income, which are associated with a higher incidence of underuse of surveillance colonoscopies 4
- Family history of colorectal cancer, which is associated with lower incidence of underuse of surveillance colonoscopies 4
- Written follow-up instructions, which can improve compliance with guidelines and ensure that patients undergo their control colonoscopy according to the instructions given 5