From the Guidelines
I recommend a follow-up colonoscopy in 7-10 years based on your findings of three tubular adenomas (two in the cecum and one in the transverse colon). The US Multi-Society Task Force Recommendations for Post-Colonoscopy Follow-Up in Average-Risk Adults With Normal Colonoscopy or Adenomas, published in 2020 in the journal Gastroenterology 1, suggest that patients with 1–2 tubular adenomas <10 mm should have a follow-up colonoscopy in 7–10 years. Although you have three adenomas, the guidelines do not specify a different follow-up interval for three small tubular adenomas, and the recommended interval for 3–4 tubular adenomas <10 mm is 3–5 years, which may not apply directly to your case.
Given the location and type of adenomas, it is essential to continue monitoring them to prevent potential colorectal cancer development. During the interim period, you should maintain a healthy lifestyle, including:
- Regular physical activity
- A diet rich in fruits and vegetables
- Limited red meat consumption
- Minimal alcohol intake Report any new symptoms such as rectal bleeding, changes in bowel habits, unexplained weight loss, or abdominal pain promptly to your doctor rather than waiting for your scheduled follow-up. Family members should be informed about these findings as they may need earlier screening themselves, as per the guidelines 1.
From the Research
Colon Polyps and Recommended Follow-up
- The patient has 2 tubular adenomas in the cecum and 1 in the transverse colon.
- The recommended follow-up for patients with 1-2 tubular adenomas <10 mm is surveillance colonoscopy in 7-10 years, according to the USMSTF guidelines 2.
- For patients with 3-4 tubular adenomas of the same size, the USMSTF recommends surveillance colonoscopy in 3-5 years 2.
- The European Society of Gastrointestinal Endoscopy (ESGE) and British Society of Gastroenterology (BSG) guidelines 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 programs 2.
Chemoprevention with Aspirin and NSAIDs
- Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce the risk of colorectal adenomas and cancer 3, 4, 5, 6.
- Low-dose aspirin (80-160 mg/day) has been found to reduce the risk of recurrent colorectal adenomas, with a relative risk of 0.80 (95% CI, 0.70-0.92) 6.
- The protective effect of aspirin and NSAIDs may persist even after treatment cessation, although the evidence is not conclusive 4, 6.
- Cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib, have also been found to reduce the recurrence of adenomas, but the effect may not persist after discontinuation 6.