What is the treatment for tubular adenoma?

From the Guidelines

Tubular adenomas should be treated with complete removal through colonoscopic polypectomy, followed by surveillance colonoscopies at intervals determined by the number, size, and histology of the adenomas, with 1-2 small tubular adenomas typically requiring a repeat colonoscopy in 7-10 years 1. The primary goal of treatment is to prevent the development of colorectal cancer by removing the adenoma and monitoring for new lesions.

• The size and number of adenomas are crucial in determining the follow-up interval, with larger adenomas or multiple adenomas requiring more frequent surveillance.
• The histology of the adenoma, including the presence of high-grade dysplasia or villous features, also influences the recommended follow-up interval.
• According to the US Multi-Society Task Force recommendations, patients with 1-2 tubular adenomas <10 mm should have a repeat colonoscopy in 7-10 years, while those with adenomas ≥10 mm or with high-grade dysplasia should have a repeat colonoscopy in 3 years 1.
• It is essential to consider individual patient factors, such as quality of baseline examination, polyp history, and patient preferences, when determining the follow-up interval.
• Patients with >10 adenomas or a lifetime cumulative total of >10 adenomas may need to be considered for genetic testing based on absolute/cumulative adenoma number, patient age, and other factors such as family history of CRC 1.

From the Research

Treatment of Tubular Adenoma

• The treatment of tubular adenoma typically involves endoscopic removal, which can be performed using various techniques such as hot snare polypectomy (HSP) or cold snare polypectomy (CSP) 2, 3, 4.
• A study comparing HSP and CSP for the removal of 4-10mm colorectal polyps found that both techniques can be effectively used for complete removal, but HSP has a lower incidence of overall complications 4.
• Another study found that CSP can be used safely for small polyps in routine colonoscopy practice, but non-inferiority for CSP could not be demonstrated compared to HSP 2.
• The choice of technique may depend on the size, morphology, location, and histopathology of the polyp, as well as the expertise of the endoscopist 5.

Risk of Incomplete Resection

• The risk of incomplete resection of tubular adenoma is a concern, particularly for polyps with serrated histology 2.
• A study found that polyps with serrated histology are more prone to incomplete resection compared to adenomas, with an odds ratio of 3.96 (95% CI 1.63-9.66) 2.
• Another study found that the overall incomplete resection rate for diminutive polyps (<6mm) was 9% (95% CI 3-19%), with 5 of 37 (14%) being adenomas 3.

Follow-up and Surveillance

• After removal of a tubular adenoma, patients are advised to undergo colonoscopy surveillance to prevent colorectal cancer (CRC) 6.
• The frequency of surveillance may depend on the size, morphology, and histopathology of the polyp, as well as the patient's individual risk factors 6.
• A study found that patients with advanced adenomas or large serrated polyps may require more intensive surveillance, while those with non-advanced adenomas or small serrated polyps may not require more intensive surveillance than patients without polyps 6.