Secondary prevention

For patients who have undergone polypectomy in order to prevent advanced adenoma or cancer formation, recommendations for the frequency of follow up are based on the size and number of polyps found.[66]​ Patients with only 1 to 2 small (<1 cm) low-grade tubular adenomas should undergo repeat colonoscopy in 5 to 10 years. Finding 3 to 10 adenomas, or any adenoma ≥1 cm, displaying high-grade dysplasia or with villous features, should prompt repeat colonoscopy at 3 years, and >10 adenomas at a single examination should prompt follow-up in <3 years, and a familial syndrome should be considered. Sessile adenomas removed piecemeal should be reviewed within 1 year to ensure complete removal.[66]

The US National Comprehensive Cancer Network guidelines recommend colonoscopy 6 months after piecemeal resection; the European Society for Gastroenterology recommends colonoscopy at 3-6 months for any piecemeal endoscopic resection of polyps ≥2 cm.​[47][67]​

People with high-risk adenomas have a three- to fourfold higher risk of incident colorectal cancer during follow-up, compared with people with no adenomas or low-risk adenomas.[49]

The National Institute for Health and Care Excellence and the British Society of Gastroenterology have provided guidelines for adenoma surveillance in the UK.[45][69]

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