From the Guidelines
If polyps are found during a colonoscopy, the follow-up screening interval should be determined based on the number, size, and type of polyps removed, with recommendations ranging from 1 to 10 years. For patients with 1-2 small (less than 10mm) tubular adenomas, a repeat colonoscopy is generally recommended in 7-10 years 1. Those with 3-10 adenomas, adenomas 10mm or larger, adenomas with villous features or high-grade dysplasia, or serrated polyps should have a follow-up colonoscopy in 3 years. Some key considerations include:
- The importance of high-quality baseline examination 1
- The option to recommend 3–5 y instead of 3-y follow-up after removal of 3–4 adenomas <10 mm in size 1
- The need for 1 y rather than <3-y follow-up after removal of >10 adenomas 1 If more than 10 adenomas are found, follow-up is recommended in 1 year. For patients with large sessile adenomas removed piecemeal, a repeat examination in 6 months is advised to ensure complete removal. After normal findings on follow-up colonoscopy, the interval typically extends to 5 years for the next examination. These recommendations are based on evidence that certain polyp characteristics indicate higher risk for developing advanced neoplasia or colorectal cancer, as outlined in the 2020 update by the US Multi-Society Task Force on Colorectal Cancer 1. The goal of surveillance is to detect and remove precancerous lesions before they progress to cancer, as the adenoma-to-carcinoma sequence typically takes 7-10 years.
From the Research
Colonoscopy Frequency After Polyp Removal
The frequency of colonoscopy after polyp removal depends on the characteristics of the polyps found. According to the study 2, a 3-month or 3-year follow-up colonoscopy is recommended after high-risk colorectal adenoma removal.
Factors Influencing Follow-up Colonoscopy
Several factors influence the decision on when to perform a follow-up colonoscopy, including:
- The type and size of the polyps removed 3
- The presence of high-grade dysplasia 3
- The patient's risk factors for colorectal cancer 4
Recommended Follow-up Intervals
The US Multi-Society Task Force recommends follow-up surveillance colonoscopy after polyp removal, with intervals depending on the most severe findings 4. The recommended intervals are:
- 3 years for patients with low-risk polyps
- 3 months or 1 year for patients with high-risk polyps, depending on the specific characteristics of the polyps
Compliance with Follow-up Guidelines
Compliance with follow-up guidelines is poor, with many patients not undergoing follow-up colonoscopy at the recommended interval 2, 4. Factors associated with poor compliance include older age and lower income 4.
Importance of Clear Follow-up Instructions
Clear follow-up instructions are essential to ensure that patients undergo follow-up colonoscopy at the recommended interval 2. Written instructions should be provided to patients, and the instructions should be included in the colonoscopy report.
Impact of Polyp Characteristics on Follow-up
The characteristics of the polyps removed, such as size and histology, influence the recommended follow-up interval 5, 3. Larger polyps and those with high-grade dysplasia require more frequent follow-up.
National Programs for Colorectal Cancer Prevention
National programs for colorectal cancer prevention, such as screening colonoscopy, can reduce the risk of colorectal cancer 5. These programs should include clear guidelines for follow-up colonoscopy after polyp removal.