From the Guidelines
For patients with tubular adenomas found during colonoscopy, the recommended timing for repeat colonoscopy is 5-10 years for a single small (less than 10mm) tubular adenoma, 3-5 years for 2-4 small tubular adenomas, and 3 years for 5 or more adenomas, large adenomas (≥10mm), or adenomas with high-grade dysplasia or villous features, as recommended by the US Multi-Society Task Force on Colorectal Cancer in 2020 1.
Key Considerations
- The number, size, and characteristics of the polyps are crucial in determining the repeat colonoscopy interval.
- A high-quality colonoscopy with complete removal of neoplastic tissue is essential for accurate risk stratification.
- Individual patient factors, such as family history and quality of bowel preparation, may influence the recommended surveillance interval.
Risk Stratification
- Patients with 1-2 adenomas < 10mm: 5-10 years 1
- Patients with 1-2 sessile serrated polyps (SSPs) > 10mm: 5-10 years 1
- Patients with 3-4 adenomas: 3-5 years 1
- Patients with 5 or more adenomas, large adenomas (≥10mm), or adenomas with high-grade dysplasia or villous features: 3 years 1
Evidence Base
The 2020 guidelines from the US Multi-Society Task Force on Colorectal Cancer provide the most recent and highest quality evidence for colonoscopy surveillance intervals 1. These guidelines supersede previous recommendations, including those from 2012 1, and should be used to inform clinical decision-making.
From the Research
Tubular Adenoma and Repeat Colonoscopy
- The risk of colorectal neoplasia after removal of conventional adenomas and serrated polyps is a significant concern, and surveillance colonoscopy is recommended to prevent subsequent colorectal cancer (CRC) 2.
- Studies have shown that patients with high-risk adenomas, including tubular adenomas, have a consistently higher risk of CRC during follow-up, with the highest risk observed at 3 years after polypectomy 2, 3.
- The use of surveillance colonoscopy has been associated with lower risk of CRC, with a hazard ratio of 0.61 (95% CI 0.39 to 0.98) among patients with high-risk polyps and 0.57 (95% CI 0.35 to 0.92) among low-risk polyps 2.
- Guidelines recommend repeat lower endoscopy within 3 years of a diagnosis of advanced adenoma, which includes tubular adenomas with high-grade dysplasia or villous histology 3.
Surveillance Intervals for Tubular Adenoma
- The optimal surveillance interval for patients with tubular adenomas is not well established, but studies suggest that repeat colonoscopy within 3 to 5 years may be appropriate 4, 3.
- Patients with nonadvanced adenomas, including small tubular adenomas, may not require more intensive surveillance than patients without polyps 3.
- The subsite distribution of index and recurrent high-risk polyps suggests that incomplete resection and missed lesions may contribute to the development of interval neoplasia, highlighting the importance of high-quality colonoscopy and surveillance 2.
Risk of Colorectal Cancer After Polyp Removal
- The risk of colorectal cancer after removal of conventional adenomas and serrated polyps is influenced by the type, size, and degree of atypicality of the polyp 5.
- Tubular adenomas have a lower risk of malignant change compared to villous adenomas, but early detection and complete removal of neoplastic polyps are essential to prevent cancer of the large bowel 5.