Colonic Polyps: The Daily PANCE Blueprint
A 52-year-old man comes in to review his first screening colonoscopy. The bowel prep was excellent, the exam reached the cecum, and two tubular adenomas, 4 mm and 6 mm, were completely removed. Pathology shows no high-grade dysplasia. He has no symptoms and no family history of colorectal cancer or polyps. Which is the most appropriate surveillance plan?
A. Repeat colonoscopy in 6 months
B. Repeat colonoscopy in 1 year
C. Repeat colonoscopy in 3 years
D. Repeat colonoscopy in 7 to 10 years
E. No more colonoscopy; annual fecal immunochemical testing instead
Answer and topic summary
The answer is D. Repeat colonoscopy in 7 to 10 years
Under the 2020 US Multi-Society Task Force guidelines, 1 to 2 tubular adenomas smaller than 10 mm, completely removed on a high-quality exam, carry a low risk, so the next colonoscopy is in 7 to 10 years. That interval is longer than the older 5-to-10-year recommendation many people still quote. The interval shortens as risk climbs: 3 to 4 small adenomas, 3 to 5 years; 5 to 10 adenomas, any adenoma 10 mm or larger, or any with villous features or high-grade dysplasia, 3 years; more than 10 adenomas, 1 year (and consider a genetic syndrome); and a polyp 20 mm or larger removed in pieces, 6 months. Small hyperplastic polyps count as a normal exam, with a 10-year interval. Once adenomas are found, stool testing is not a substitute; he needs colonoscopic surveillance. Pearl: prep quality and a complete exam are part of the decision, and a poor prep means repeating the colonoscopy sooner.
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Covered under ⇒ PANCE Blueprint Gastroenterology ⇒ ⇒
