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What review period do you recommend for patients with previously identified polyps?

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What review period do you recommend for patients with previously identified polyps?

Unfortunately, there is no simple answer to this question. Follow-up recommendations vary widely across countries, specialties, expert committees and “expert” guidelines!

The Gastroenterological Society of Australia and the American Gastroenterological Association recommend:

  • One to two small tubular adenomas with low grade dysplasia – follow up in five years.
  • Adenomas greater than 1cm, more than two polyps, polyps with any villous component, or more than low grade dysplasia – follow-up three years.
  • Sessile serrated adenomas (SSA) follow-up three years.

Others believe five years is too long for tubular adenoma follow-up. In practice the issue is much more complex. Factors such as family history, length of colon, quality of bowel preparation, age, and co-morbidities all have to be taken into consideration.

Particularly with sessile polyps the difficulty of removal and the degree of certainty that the polyp has been totally removed are very important.

There are a series of clinical and histological factors which determine if polypectomy is adequate treatment for a malignant polyp or if surgery is required.

A number of special syndromes (FAP, HNPCC, Flat Adenoma Syndrome, Familial Giant Hyperplastic Polyps Syndrome etc), all have their own special follow-up programs.

We do not routinely recommend follow-up for patients over 80. However, if they remain in good health at this age follow-up is reasonable.

There are different opinions about hyperplastic polyps. 2–4mm rectal hyperplastic polyps are of little significance. Larger hyperplastic polyps are followed on a 3–10 year basis depending upon the number size and other factors.