What are the follow-up recommendations for repeat colonoscopy in a patient with a tubular adenoma and negative for high-grade dysplasia, and also found to have hyperplastic polyp fragments?

From the Guidelines

For a patient with one tubular adenoma without high-grade dysplasia and two hyperplastic polyp fragments, the recommended follow-up colonoscopy should be performed in 5 to 10 years. This recommendation applies to patients at average risk for colorectal cancer who have had a high-quality colonoscopy with adequate bowel preparation and complete examination to the cecum 1.

Key Considerations

• Tubular adenomas are precancerous lesions but those without high-grade dysplasia and smaller than 1 cm have a relatively low risk of progression to cancer.
• Hyperplastic polyps, particularly those in the rectosigmoid region, are generally considered non-neoplastic with minimal malignant potential.
• If the patient has additional risk factors such as a family history of colorectal cancer, Lynch syndrome, inflammatory bowel disease, or previous advanced adenomas, the surveillance interval should be shortened accordingly.

Surveillance Intervals

• Patients with small rectal hyperplastic polyps should be considered to have normal colonoscopies, and therefore the interval before the subsequent colonoscopy should be 10 years.
• Patients with only one or two small (<1 cm) tubular adenomas with only low-grade dysplasia should have their next follow-up colonoscopy in 5 to 10 years.

Importance of Continued Screening

It's also important to continue age-appropriate colorectal cancer screening after this interval. The precise timing within the recommended interval should be based on other clinical factors (such as prior colonoscopy findings, family history, and the preferences of the patient and judgment of the physician) 1.

From the Research

Follow-up Recommendations for Repeat Colonoscopy

The patient has been diagnosed with a tubular adenoma and two hyperplastic polyp fragments, with no high-grade dysplasia. Based on the studies, the follow-up recommendations for repeat colonoscopy are:

• The risk of advanced adenoma is low, but higher among men than women 2
• The 5-year risk of colorectal cancer is extremely low for patients with no colorectal neoplasia on initial screening colonoscopy 2
• The risk of advanced adenoma does not differ significantly between persons with no polyps at baseline and those with hyperplastic polyps at baseline 2
• A fraction of advanced adenomas can occur in polyps of any size, including those less than 10mm 3
• The frequency of advanced histopathology increases with polyp size, but one quarter of all advanced histopathology exists in polyps of <10mm 3

Key Considerations

• The patient's tubular adenoma was negative for high-grade dysplasia, which suggests a lower risk of advanced adenoma
• The presence of hyperplastic polyp fragments does not significantly increase the risk of advanced adenoma 2
• The patient's risk factors, such as age and sex, should be taken into account when determining the follow-up interval for repeat colonoscopy 2

Follow-up Interval

• A rescreening interval of 5 years or longer may be appropriate for patients with a normal colonoscopic examination and no high-grade dysplasia 2
• However, the patient's individual risk factors and the presence of a tubular adenoma should be considered when determining the follow-up interval 2, 3