What is the recommended colonoscopy follow-up interval for a patient with a history of tubular adenoma (tubular adenoma)?

From the Guidelines

The recommended colonoscopy follow-up interval for a patient with a prior tubular adenoma is typically 5-10 years, depending on specific findings, as stated in the guidelines from the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society 1.

Key Considerations

• For patients with 1-2 small (<10mm) tubular adenomas with low-grade dysplasia, a 5-10 year follow-up interval is recommended, with the precise timing based on other clinical factors such as prior colonoscopy findings, family history, and patient preferences 1.
• Patients with 3-10 adenomas, or any adenoma ≥ 1 cm, or any adenoma with villous features or high-grade dysplasia should have their next follow-up colonoscopy in 3 years, provided that piecemeal removal has not been performed and the adenomas are completely removed 1.
• The follow-up interval should be personalized based on the quality of the preparation during the initial colonoscopy, the completeness of polyp removal, the patient's family history, and other risk factors.

Risk Stratification

• Patients with a history of multiple adenomas or advanced adenomas are at higher risk of developing subsequent advanced adenomas and should be considered for shorter follow-up intervals 1.
• Patients with a family history of colorectal cancer or adenomatous polyps should also be considered for more intensive surveillance 1.

Clinical Judgment

• Clinical judgment should be used to determine the optimal follow-up interval for each patient, taking into account individual risk factors and preferences 1.
• The guidelines are intended to be used as a guide, and clinicians should use their judgment to determine the best course of action for each patient.

From the Research

Recommended Colonoscopy Follow-up Interval for Prior Tubular Adenoma

• The recommended follow-up interval for patients with prior tubular adenoma is every 5-10 years, as stated in the study published in Gastroenterology 2.
• This guideline is based on the fact that endoscopists do not routinely follow guidelines to survey individuals with low-risk adenomas (LRAs; 1-2 small tubular adenomas, < 1 cm) every 5-10 years for colorectal cancer.
• However, some endoscopists recommend shorter surveillance intervals for individuals with LRAs, with factors such as African American race, Asian/Pacific Islander ethnicity, detection of 2 adenomas at the index examination, and family history of colorectal cancer associated with a 3-year surveillance interval recommendation 2.
• The study found that there were no significant differences in outcomes between the 3-year and 5-year recommendation groups in terms of proportions of subjects found to have 1 or more adenomas, advanced adenomas, or serrated polyps at the follow-up colonoscopy 2.
• Other studies have focused on the prevalence of proximal colonic polyps in average-risk asymptomatic patients with negative fecal occult blood tests and flexible sigmoidoscopy 3, the effectiveness of flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals 4, and the sensitivity of one-time screening with a fecal occult-blood test plus sigmoidoscopy for detecting neoplasia 5.
• An earlier study evaluated the effectiveness of using the fecal occult blood test in conjunction with sigmoidoscopy to screen for colorectal cancer, and found that this approach can increase the likelihood of early detection of the disease 6.