From the Guidelines
For patients with one or two small (< 1 cm) tubular adenomas with only low-grade dysplasia, the next follow-up colonoscopy is recommended in 5-10 years, as stated in the most recent and highest quality study 1. The follow-up timing for colonoscopy after removal of a tubular adenoma depends on the number and size of polyps.
- For 1-2 small tubular adenomas with low-grade dysplasia, repeat colonoscopy is recommended in 5-10 years, based on the guidelines from the American Family Physician 1.
- For 3-10 adenomas, any adenoma ≥ 1 cm, or any adenoma with villous features or high-grade dysplasia, the next follow-up colonoscopy is recommended in 3 years, provided that piecemeal removal has not been done and the adenomas are completely removed, as recommended by the U.S. Multi-Society Task Force on Colorectal Cancer and the American Cancer Society 1.
- For patients with more than 10 adenomas, genetic evaluation should be considered and follow-up colonoscopy performed at a shorter interval, established by clinical judgment, as suggested by the guidelines from the American Family Physician 1. The rationale for surveillance is that patients with adenomas are at higher risk for developing additional adenomas and colorectal cancer, and the goal is to remove precancerous lesions before they progress to cancer, as the adenoma-to-carcinoma sequence typically takes 7-10 years, as explained in the study by Winawer et al. 1. Patients should maintain regular follow-up with their gastroenterologist and report any concerning symptoms like rectal bleeding, change in bowel habits, or abdominal pain between scheduled colonoscopies, as recommended by the American Family Physician 1. It is essential to consider other clinical factors, such as previous colonoscopy findings, family history, and patient preferences, when determining the precise timing of follow-up colonoscopy, as stated in the guidelines from the U.S. Multi-Society Task Force on Colorectal Cancer and the American Cancer Society 1.
From the Research
Guidelines for Follow-up Colonoscopy
The guidelines for follow-up colonoscopy after removal of a tubular adenoma are as follows:
- Total colonoscopy at the time of endoscopic polypectomy to obtain a "clean colon" 2
- First check at 3 years and, if negative, subsequent check at 5 years 2
- For small tubular adenomas, surveillance is indicated only in the case of multiple adenomas 2
- Patients newly diagnosed with three or more adenomas, an adenoma of more than 0.5 cm, or with a family history of colorectal cancer should have surveillance colonoscopy at 3 years following the polypectomy 3
- Surveillance of patients with single, small tubular adenomas can be extended to 5 or more years 3
Risk Factors for Adenoma Recurrence
Risk factors for adenoma recurrence include:
- Family history 2, 3
- Age 2, 4
- Size of adenoma 2, 3, 5
- Multiple adenomas 2, 3, 4
- Dysplasia 2, 5
- Villous histotype 2
Surveillance Intervals
The optimal surveillance interval is still a matter of debate, but the following intervals have been suggested: