From the Guidelines
A follow-up colonoscopy is recommended in 3 years based on the findings of multiple tubular adenomas. You have two 5 mm polyps in the ascending colon and three 7 mm polyps in the descending colon, all identified as tubular adenomas. These are considered low-risk adenomas due to their small size (less than 10 mm) and tubular histology. The presence of multiple adenomas (five in total) increases your risk for developing advanced neoplasia in the future, which is why surveillance is important, as suggested by the guidelines for colonoscopy surveillance after polypectomy 1.
Some key points to consider:
- The guidelines recommend that patients with 3 to 10 adenomas should have their next follow-up colonoscopy in 3 years, providing that the adenoma(s) are removed completely 1.
- The presence of multiple adenomas increases the risk of developing advanced neoplasia, making regular surveillance important.
- Maintaining a healthy lifestyle with regular physical activity, a diet rich in fruits and vegetables, limited red meat consumption, and avoiding tobacco and excessive alcohol may help reduce the risk of developing new polyps.
- If you have a family history of colorectal cancer or other risk factors, your doctor might recommend a shorter interval for follow-up, as more intensive surveillance is indicated when the family history may indicate HNPCC 1.
During the follow-up colonoscopy, any new polyps can be removed before they potentially progress to cancer. It is essential to adhere to the recommended follow-up schedule to ensure early detection and removal of any new polyps, reducing the risk of colorectal cancer.
From the Research
Polyp Characteristics
- 2 polyps, 5 mm in size, located in the ascending colon
- 3 polyps, 7 mm in size, located in the descending colon
- All polyps are tubular adenomas
Recommended Follow-up
- According to the guidelines outlined in 2, patients with one or two tubular adenomas that are smaller than 10 mm should have a repeat colonoscopy in five to 10 years
- However, since there are three polyps in this case, the recommended follow-up is a repeat colonoscopy in three years, as stated in 2 for patients with three to 10 adenomas found during a single colonoscopy
- This recommendation is supported by the study in 3, which found that patients with low-risk adenomas (one to two tubular adenomas <1 cm in size without high-grade dysplasia) have a higher risk of metachronous advanced neoplasia than those without neoplasia at baseline colonoscopy
Additional Considerations
- The study in 4 highlights the importance of the gut microbiome in colorectal cancer development, but does not provide direct guidance on follow-up recommendations for patients with tubular adenomas
- The guidelines outlined in 2 provide a framework for determining the appropriate follow-up interval based on the number and characteristics of the polyps found during colonoscopy