What is the recommended follow-up for a patient with a history of one tubular adenoma found during a previous colonoscopy?

From the Guidelines

The recommended follow-up for a patient with a history of one tubular adenoma found during a previous colonoscopy is 7-10 years.

Key Considerations

• The US Multi-Society Task Force recommends a follow-up interval of 7-10 years for patients with 1-2 tubular adenomas <10 mm 1, 2.
• This recommendation is based on the risk of colorectal cancer outcomes, rather than just the risk of advanced adenoma during surveillance 2.
• The quality of the baseline examination and patient preferences should also be taken into account when determining the follow-up interval 1.
• Patients with a family history of CRC or other high-risk factors may require more intensive surveillance 3, 4.

Surveillance Intervals

• The recommended surveillance intervals are as follows:
  • 1-2 tubular adenomas <10 mm: 7-10 years 1, 2
  • 3-4 tubular adenomas <10 mm: 3-5 years 1
  • Adenoma ≥10 mm: 3 years 1
  • Adenoma with tubulovillous or villous histology: 3 years 1
  • Adenoma with high-grade dysplasia: 3 years 1 ### Important Notes
• These recommendations assume a complete examination to the cecum with adequate bowel preparation 1.
• Patients with >10 adenomas or lifetime >10 cumulative adenomas may need to be considered for genetic testing 1.

From the Research

Follow-up Recommendations for Patients with a History of Tubular Adenoma

• The recommended follow-up for a patient with a history of one tubular adenoma found during a previous colonoscopy is to have their next colonoscopy in five to 10 years 5.
• This guideline applies to patients with one or two small (less than 1 cm) tubular adenomas, including those with only low-grade dysplasia 5.
• A study published in 2017 found that endoscopists frequently recommend 3-year surveillance intervals instead of guideline-recommended intervals of 5 years or longer for individuals with low-risk adenomas, but found no significant differences in outcomes between the 3-year vs 5-year recommendation groups 6.
• Another study published in 2019 found that the risk of advanced neoplasia following a small adenoma was lower than that following an advanced adenoma, and suggested that reducing the frequency of colonoscopy while providing regular fecal immunochemical testing (FIT) might be a more efficient use of resources for this population 7.
• The updated guidelines for post-polypectomy colonoscopy surveillance published in 2021 recommend different surveillance intervals after detection of specific types of polyps, with the USMSTF recommending surveillance colonoscopies 7-10 years after diagnosis of 1-2 tubular adenomas <10 mm 8.
• A study published in 2009 found that metachronous adenomas are generally smaller, usually tubular in shape, and bear high-grade dysplasia less often than initial adenomas, and suggested that regular follow-up colonoscopy can provide sufficient colorectal carcinoma prevention 9.

Factors Influencing Follow-up Recommendations

• Factors that may influence the recommendation for a shorter surveillance interval include African American race, Asian/Pacific Islander ethnicity, detection of 2 adenomas at the index examination, more than 3 serrated polyps at the index examination, or index examination with fair or poor quality bowel preparation 6.
• Family history of colorectal cancer and detection of 1-2 serrated polyps at the index examination may also be associated with a recommendation for a shorter surveillance interval 6.
• A positive FIT was found to be an independent predictor of advanced neoplasia after a small adenoma at baseline colonoscopy 7.