What is the recommended follow-up interval for a 0.7 cm tubular adenoma (colorectal polyp)?

Follow-Up Interval for 0.7 cm Tubular Adenoma

A 0.7 cm tubular adenoma should be followed up with colonoscopy in 7-10 years. 1

Risk Stratification Based on Polyp Characteristics

• The 0.7 cm tubular adenoma falls into the low-risk category as it is:

  • Less than 10 mm in size (0.7 cm = 7 mm) 1
  • A tubular adenoma (not tubulovillous or villous) 1
  • Presumably with low-grade dysplasia (not specified otherwise) 1
  • A single adenoma (not multiple) 1

• The 2020 US Multi-Society Task Force on Colorectal Cancer updated their recommendations to extend the follow-up interval for 1-2 tubular adenomas <10 mm from 5-10 years to 7-10 years 1

Evidence Supporting This Recommendation

• The risk of advanced neoplasia at follow-up for patients with 1-2 small (<10 mm) tubular adenomas is very low, approximately 4.5-6.2% over 5-10 years 1

• Patients with 1-2 tubular adenomas <10 mm have only a small, non-significant increase in risk of advanced neoplasia compared to individuals with no baseline neoplasia 1

• In a pooled analysis of 8 studies, patients with 1-2 small tubular adenomas had a much lower risk of advanced adenomas at follow-up compared to those with larger adenomas or multiple adenomas 1

Important Considerations for Implementation

• This recommendation assumes:

  • The baseline colonoscopy was high-quality (complete examination to cecum, adequate bowel preparation) 1, 2
  • Complete removal of the adenoma was achieved 1, 2
  • The patient has no other high-risk factors (family history, genetic syndromes) 2

• If the bowel preparation was inadequate during the baseline colonoscopy, a shorter interval might be prudent as the miss rates for adenomas can be as high as 35% 1

Common Pitfalls to Avoid

• Many primary care physicians recommend more frequent surveillance than guidelines suggest, especially for small adenomas, leading to overutilization of colonoscopy 3

• There is no evidence supporting complete spontaneous regression of adenomas, so follow-up is still necessary even for small tubular adenomas 4

• Extending the surveillance interval beyond recommendations could miss interval lesions, while too-frequent surveillance exposes patients to unnecessary procedural risks 1

Subsequent Surveillance Recommendations

• If the follow-up colonoscopy at 7-10 years is normal or shows only 1-2 small tubular adenomas with low-grade dysplasia, subsequent examination can be scheduled for 7-10 years later 1

• If higher-risk findings are discovered at follow-up (≥3 adenomas, adenomas ≥10 mm, or adenomas with villous features or high-grade dysplasia), the surveillance interval should be shortened to 3 years 1, 2