Monitoring

Surveillance after polypectomy is individualized to the patient's risk of colorectal cancer. Colorectal cancer risk is determined by the presence, number, and size of polyps found at index colonoscopy, as well as by factors such as age and family history.

Patients with adenomas who have had a polypectomy are at high risk of developing future colorectal cancer if they have:[45]

  • ≥2 premalignant polyps, including at least one advanced colorectal polyp (a serrated polyp ≥10 mm containing any grade of dysplasia, or an adenoma ≥10 mm or containing high-grade dysplasia); or

  • ≥5 premalignant polyps.

British guidelines recommend that these patients have a surveillance colonoscopy after 3 years.[45]

The American Gastroenterological Association (AGA) has issued the following Best Practice Advice statements on post-polypectomy surveillance based on published literature and expert opinion:[48]

  • For individuals ages >75 years, post-polypectomy surveillance decisions should be individualized, taking into account risks, benefits, and comorbidities.

  • All risk stratification tools for post-polypectomy surveillance derived from research should be examined for real-world effectiveness and cost-effectiveness in diverse populations before implementation.

The US National Comprehensive Cancer Network guidelines recommend that if a patient has had invasive adenocarcinoma in a polyp that was completely excised, colonoscopy should be performed 1 year after index colonoscopy.[68] If an advanced adenoma (villous polyp, polyp >10 mm, or high-grade dysplasia) is present, colonoscopy should be repeated after 1 year. If there is no advanced adenoma, colonoscopy is recommended at 3 years, and then every 5 years.[68]

The AGA guidelines recommend the follow-up of patients found to have high-risk adenomas (HRAs), defined as any adenoma ≥10 mm, or with high-grade dysplasia or villous histology; or those with advanced sessile serrated lesions (SSLs), defined as a ≥10 mm lesion, those with cytologic dysplasia, or a traditional serrated adenoma.[49] People with HRAs 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]

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