Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
For the purposes of the post, we will assume that this is an average risk patient who underwent a routine screening colonoscopy at the age of 50 years. The answer to the question depends on why the patient had colonoscopy in the first place and the type/size of polyp etc.
This post does not address malignant polyps or the patients who are at high risk for colon cancer, e.g. those with family history of colon cancer etc.
TYPE OF POLYP:
Many kinds of polyps do not have predisposition to cancer and such the follow-up usually is as if they were not present at all. These include hyperplastic polyps, juvenile polyps etc.
At the time of writing, the recommended interval is 10 years. Exceptions may be if they were numerous or large especially right sided hyperplastic polyps or the colonoscopic exam was suboptimal.
Tubular, tubulovillous and villous adenomas are neoplastic and have predisposition to go on to cancer. An adenoma once formed may (or may not) progress to cancer. If it does, it goes on to form cancer in about 7-10 years. Thus, while about 95% of colon cancers arise from such adenomas, not all such adenomas shall transform into cancer.
The risk factors for progression to cancer include large adenomatous polyps (greater than 1 cm in diameter)), those with high-grade dysplasia or villous type. Sometimes cancer may be present in the polyp that is removed.
FOLLOW-UP RECOMMENDATIONS:
Different societies e.g. American College of Gastroenterology, American Gastroenterological Association and American Cancer Society have different recommendations. These the recommendations need to be individualized to the patient's specific situation and only your doctor can make the best assessment of your case.
If the polyp found is large, (greater than 2cm), sessile i.e. without stalk, or if there is concern that there still may be residual polyp left despite excision, a repeat colonoscopy should be performed in three to four months.
Surgical consult is warranted if complete excision not possible after 2-3 colonoscopies.
Advanced polyps
Advanced (size more than 1 cm, tubulovillous or villous) adenomas and those with three or more adenomas should have repeat colonoscopy in three years assuming complete excision and a good exam with a good colon preparation. After one normal exam, the interval should be increased to five years.
Small polyps
Patients with one small adenoma may have repeat exam in 10 years whereas those with two small tubular adenomas may benefit from repeat colonoscopy in 5 years.
A normal colonoscopy on a good colonic preparation in average risk patient calls for a repeat exam in 10 years.
Screening is generally discontinued after the age of 75 years in most patients.
Dr. Minocha's comments
Of note, recent studies/guidelines have suggested extended intervals while there are also studies that longer intervals may results in adverse outcomes. Overall talk to your doctor about what is best for you. Opinions vary among gastroenterologists.
Large studies may not apply to your individual characteristics and guidelines and expert opinions keep changing.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
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