What is the recommended follow-up for a 5 mm tubular adenoma (tubular adenoma, a type of colorectal polyp)?

From the Guidelines

For a 5 mm tubular adenoma, the recommended follow-up is a surveillance colonoscopy in 5 to 10 years. This timing applies to patients with 1 or 2 small tubular adenomas with low-grade dysplasia, which are considered low-risk findings 1. The extended interval is appropriate because small tubular adenomas have a relatively low risk of progressing to advanced neoplasia or colorectal cancer.

Key Considerations

• The adenoma must have been completely removed
• The bowel preparation was adequate
• The examination was thorough with good visualization of the entire colon If you have a family history of colorectal cancer, personal history of inflammatory bowel disease, or other risk factors, your doctor might recommend a shorter surveillance interval 1.

Additional Recommendations

• It's also important to continue age-appropriate colorectal cancer screening after this surveillance colonoscopy
• If any symptoms develop before your next scheduled colonoscopy, such as rectal bleeding, change in bowel habits, or unexplained weight loss, you should consult your healthcare provider promptly rather than waiting for your scheduled surveillance 1. Some key points to consider when deciding on the follow-up interval include:
• The number and size of the adenomas
• The grade of dysplasia
• The completeness of removal
• The patient's family history and other risk factors 1. In general, the follow-up interval should be individualized based on the patient's specific risk factors and the results of the initial colonoscopy. The most recent and highest quality study recommends a follow-up interval of 5 to 10 years for patients with 1 or 2 small tubular adenomas with low-grade dysplasia 1.

From the Research

Recommended Follow-up for a 5 mm Tubular Adenoma

• The recommended follow-up for a 5 mm tubular adenoma is not explicitly stated in the provided studies, but we can infer the recommended follow-up based on the studies.
• According to the study 2, the USMSTF recommends surveillance colonoscopies 7-10 years after diagnosis of 1-2 tubular adenomas <10 mm.
• However, the study 3 suggests that endoscopists frequently recommend 3-year surveillance intervals instead of guideline-recommended intervals of 5 years or longer for individuals with low-risk adenomas (LRAs; 1-2 small tubular adenomas, < 1 cm).
• The study 4 found that patients with diminutive index polyps (≤ 5 mm in diameter) had a substantial prevalence of proximal colonic neoplasms, including advanced lesions, which warrants colonoscopy in these patients.
• The study 5 found that patients who initially had single adenomatous polyps developed new polyp(s) after a mean time of 23 months, while patients with two or more adenomatous polyps initially developed new polyp(s) after a mean time of 13.5 months.
• The study 6 found that primary care physicians recommend postpolypectomy colonoscopic surveillance more frequently than is recommended by practice guidelines, especially if the colonoscopy showed a hyperplastic polyp or a single small adenoma.

Surveillance Intervals

• The USMSTF recommends surveillance colonoscopies 7-10 years after diagnosis of 1-2 tubular adenomas <10 mm 2.
• The ESGE and BSG do not recommend colonoscopic surveillance for patients with 1-4 adenomas <10 mm with low-grade dysplasia, and instead recommend participation in routine CRC screening program 2.
• Endoscopists frequently recommend 3-year surveillance intervals instead of guideline-recommended intervals of 5 years or longer for individuals with LRAs 3.