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Villous Adenoma Follow-up

  • Author: Alnoor Ramji, MD, FRCPC; Chief Editor: Julian Katz, MD  more...
 
Updated: Dec 16, 2014
 

Further Outpatient Care

See the list below:

  • 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

See the list below:

  • Hemorrhage
  • Obstruction
  • Bowel torsion
  • Malignant transformation
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Prognosis

See the list below:

  • 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

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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Contributor Information and Disclosures
Author

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

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, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

References
  1. Ferlitsch M, Reinhart K, Pramhas S, Wiener C, Gal O, Bannert C, et al. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA. 2011 Sep 28. 306(12):1352-8. [Medline].

  2. Fairley KJ, Li J, Komar M, Steigerwalt N, Erlich P. Predicting the risk of recurrent adenoma and incident colorectal cancer based on findings of the baseline colonoscopy. Clin Transl Gastroenterol. 2014 Dec 4. 5:e64. [Medline].

  3. Wark PA, Wu K, van 't Veer P, Fuchs CF, Giovannucci EL. Family history of colorectal cancer: a determinant of advanced adenoma stage or adenoma multiplicity?. Int J Cancer. 2009 Jul 15. 125(2):413-20. [Medline].

  4. Terhaar Sive Droste JS, Craanen ME, van der Hulst RW, Bartelsman JF, Bezemer DP, Cappendijk KR, et al. Colonoscopic yield of colorectal neoplasia in daily clinical practice. World J Gastroenterol. 2009 Mar 7. 15(9):1085-92. [Medline]. [Full Text].

  5. Martinez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009 Mar. 136(3):832-41. [Medline].

  6. de Jonge V, Sint Nicolaas J, van Leerdam ME, Kuipers EJ, Veldhuyzen van Zanten SJ. Systematic literature review and pooled analyses of risk factors for finding adenomas at surveillance colonoscopy. Endoscopy. 2011 Jul. 43(7):560-72. [Medline].

  7. Denis B, Peters C, Chapelain C, et al. Diagnostic accuracy of community pathologists in the interpretation of colorectal polyps. Eur J Gastroenterol Hepatol. 2009 Aug 18. epub ahead of print. [Medline].

  8. Bokemeyer B, Bock H, Huppe D, et al. Screening colonoscopy for colorectal cancer prevention: results from a German online registry on 269000 cases. Eur J Gastroenterol Hepatol. 2009 Jun. 21(6):650-5. [Medline].

  9. Cole BF, Logan RF, Halabi S, et al. Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials. J Natl Cancer Inst. 2009 Feb 18. 101(4):256-66. [Medline].

  10. Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med. 2003 Mar 6. 348(10):891-9. [Medline].

  11. Bond JH. Colon polyps and cancer. Endoscopy. 2001 Jan. 33(1):46-54. [Medline].

  12. Bond JH. Colorectal cancer update. Prevention, screening, treatment, and surveillance for high-risk groups. Med Clin North Am. 2000 Sep. 84(5):1163-82, viii. [Medline].

  13. Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 2000 Nov. 95(11):3053-63. [Medline].

  14. Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with nonfamilial colorectal polyps. The Practice Parameters Committee of the American College of Gastroenterology. Ann Intern Med. 1993 Oct 15. 119(8):836-43. [Medline].

  15. Cotton PB, Durkalski VL, Pineau BC, Palesch YY, Mauldin PD, Hoffman B, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA. 2004 Apr 14. 291(14):1713-9. [Medline].

  16. Day DW, Morson BC. The adenoma-carcinoma sequence. Morson BC, ed. The Pathogenesis of Colorectal Cancer. Philadelphia: WB Saunders; 1978. 58-71.

  17. DuBois RN, Giardiello FM, Smalley WE. Nonsteroidal anti-inflammatory drugs, eicosanoids, and colorectal cancer prevention. Gastroenterol Clin North Am. 1996 Dec. 25(4):773-91. [Medline].

  18. Farnell MB, Sakorafas GH, Sarr MG, Rowland CM, Tsiotos GG, Farley DR, et al. Villous tumors of the duodenum: reappraisal of local vs. extended resection. J Gastrointest Surg. 2000 Jan-Feb. 4(1):13-21, discussion 22-3. [Medline].

  19. Gibbs ER, Walton GF, Kent RB 3rd, Laws HL. Villous tumors of the ampulla Vater. Am Surg. 1997 Jun. 63(6):467-71. [Medline].

  20. Heald RJ, Bussey HJ. Clinical experiences at St. Mark's Hospital with multiple synchronous cancers of the colon and rectum. Dis Colon Rectum. 1975 Jan-Feb. 18(1):6-10. [Medline].

  21. Itzkowitz SH, Kim YS. Colonic polyps and polyposis syndromes. Feldman M, Scharschmidt BF, Sleisenger MH. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. 6th ed. Philadelphia, Pa: WB Saunders; 1997. 467-71.

  22. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993 May 13. 328(19):1365-71. [Medline].

  23. Morson BC, Dawson IMP. Gastrointestinal Pathology. Oxford: Blackwell Scientific; 1972.

  24. O'Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990 Feb. 98(2):371-9. [Medline].

  25. Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003 Dec 4. 349(23):2191-200. [Medline].

  26. Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med. 2003 Mar 6. 348(10):883-90. [Medline].

  27. Schrock TR. Colonoscopy for colorectal cancer: too much, too little, just right. ASGE Distinguished Lecture 1993. Gastrointest Endosc. 1993 Nov-Dec. 39(6):848-51. [Medline].

  28. Seitz U, Bohnacker S, Seewald S, Thonke F, Brand B, Braiutigam T, et al. Is endoscopic polypectomy an adequate therapy for malignant colorectal adenomas? Presentation of 114 patients and review of the literature. Dis Colon Rectum. 2004 Nov. 47(11):1789-96; discussion 1796-7. [Medline].

  29. Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987 Nov. 93(5):1009-13. [Medline].

  30. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O'Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006 May. 130(6):1872-85. [Medline].

  31. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993 Dec 30. 329(27):1977-81. [Medline].

  32. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, et al. The National Polyp Study. Eur J Cancer Prev. 1993 Jun. 2 Suppl 2:83-7. [Medline].

  33. Winawer SJ, Zauber AG, O'Brien MJ, Ho MN, Gottlieb L, Sternberg SS, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993 Apr 1. 328(13):901-6. [Medline].

  34. Zauber AG, Winawer SJ. Initial management and follow-up surveillance of patients with colorectal adenomas. Gastroenterol Clin North Am. 1997 Mar. 26(1):85-101. [Medline].

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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.
Fecal occult blood testing. Video courtesy of Therese Canares, MD; Marleny Franco, MD; and Jonathan Valente, MD (Rhode Island Hospital, Brown University).
 
 
 
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