Villous Adenoma Follow-up

  • Author: Alnoor Ramji, MD, FRCPC; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 4, 2012
 

Further Outpatient Care

  • Surveillance colonoscopy (after initial colonoscopy and clearing of polyps)
    • Patients with small rectal hyperplastic polyps should be considered to have normal colonoscopies. The interval before the subsequent colonoscopy could be 10 years.
    • Patients with 3-10 adenomas, any adenoma 1 cm, any adenoma with villous features, or high-grade dysplasia should have their next follow-up colonoscopy within 3 years.
    • Patients who have more than 10 adenomas should be reexamined at a shorter interval (< 3 y), based on clinical judgment. The clinician should consider the possibility of an underlying familial syndrome.
    • Patients with only 1-2 small (< 1 cm) tubular adenomas with only low-grade dysplasia should have their next follow-up colonoscopy probably in 5 years.
    • Patients with sessile adenomas that are removed piecemeal should be considered for follow-up evaluation at short intervals (ie, 2-6 mo) to verify complete removal.
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Complications

  • Hemorrhage
  • Obstruction
  • Bowel torsion
  • Malignant transformation
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Prognosis

  • Transformation to malignancy is a primary consideration in villous adenomas.
    • Villous adenomas have a malignant risk of 15-25%. The risk of adenocarcinoma approaches 40% in villous adenomas larger than 4 cm in diameter.
    • Villous adenomas of the ampulla of Vater contain carcinoma in 30-50% of patients.
    • Carcinoma is found in 20-25% of duodenal villous adenomas.
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Patient Education

  • Emphasize the importance of continued surveillance once polyps are identified.
  • Provide screening information for family members when appropriate.
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Contributor Information and Disclosures
Author

Alnoor Ramji, MD, FRCPC  Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada

Alnoor Ramji, MD, FRCPC is a member of the following medical societies: Canadian Society of Internal Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Eric M Yoshida, MD, MHSc, FRCPC, FACP  Program Director of Adult Gastroenterology Training Program, Assistant Professor, Department of Medicine, Division of Gastroenterology, University of British Columbia

Disclosure: Nothing to disclose.

Specialty Editor Board

Manoop S Bhutani, MD  Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James L Achord, MD  Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine

James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Endoscopic view of a sessile polyp, which histology studies revealed to be a villous adenoma. Courtesy of H. Chaun, MD.
Endoscopic view of a sessile polyp histologically determined to be a villous adenoma. Courtesy of R. Enns, MD.
Endoscopic view of injection of saline into the base of a sessile polyp histologically determined to be a villous adenoma. This enables an easier polypectomy. Courtesy of R. Enns, MD.
Polypectomy with a snare around a sessile polyp base (villous adenoma) injected with saline. Courtesy of R. Enns, MD.
Histology of villous adenoma. Fingerlike projections stretching from the surface of a polyp downward with minimal branching. Courtesy of D. Owen, MD.
Histology of villous adenoma. Low-grade dysplasia with loss of mucin, prominent nucleoli, and hyperchromatic and elongated cells. Courtesy of D. Owen, MD.
 
 
 
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