Villous Adenoma Follow-up
- Author: Alnoor Ramji, MD, FRCPC; Chief Editor: Julian Katz, MD more...
Further Outpatient Care
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- 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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- Bowel torsion
- Malignant transformation
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- 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.
See the list below:
- Emphasize the importance of continued surveillance once polyps are identified.
- Provide screening information for family members when appropriate.
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