eMedicine Specialties > Gastroenterology > Colon

Villous Adenoma: Follow-up

Author: Alnoor Ramji, MD, FRCPC, Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
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
Contributor Information and Disclosures

Updated: Aug 29, 2009

Follow-up

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.

Complications

  • Hemorrhage
  • Obstruction
  • Bowel torsion
  • Malignant transformation

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.

Patient Education

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

Miscellaneous

Medicolegal Pitfalls

  • Failure to discuss the material risks of endoscopy with patients and failure to instruct patients to schedule follow-up if they suspect complications
  • Failure to carefully document polyp morphology, size, and location at endoscopy
  • Failure to send all biopsies for identification of tissue histology
  • Failure to perform regular follow-up evaluations for patients with polyps and failure to discuss implications for family members when appropriate
 


More on Villous Adenoma

Overview: Villous Adenoma
Differential Diagnoses & Workup: Villous Adenoma
Treatment & Medication: Villous Adenoma
Follow-up: Villous Adenoma
Multimedia: Villous Adenoma
References
Further Reading
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References

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Further Reading

Clinical guidelines

Guidelines for colonoscopy surveillance after polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society.
American Cancer Society - Disease Specific Society
American Gastroenterological Association Institute - Medical Specialty Society.  2006 May.  17 pages.  NGC:006080

Surveillance and management of groups at increased risk of colorectal cancer.
New Zealand Guidelines Group - Private Nonprofit Organization.  2004 May.  84 pages.  NGC:003655

Quality indicators for colonoscopy.
American College of Gastroenterology - Medical Specialty Society
American Society for Gastrointestinal Endoscopy - Medical Specialty Society.  2006 Apr.  13 pages.  NGC:004969

Colorectal cancer screening.
Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1995 May (revised 2008 Jun).  27 pages.  NGC:006580

Routine aspirin and non-steroidal anti-inflammatory drug (NSAID) prophylaxis for colorectal cancer prevention.
United States Preventive Services Task Force - Independent Expert Panel.  2007 Mar.  5 pages.  NGC:005452

Clinical trials

Randomised Trial of NBI for Adenoma Detection

Selenium in Treating Patients With Adenomatous Colorectal Polyps

A Prospective, Single Blinded Study for Predicting Colon Polyp Histology With Narrow Band Imaging (NBI)

Chemoprevention of Colorectal Adenomas

Prevention of Progression of Duodenal Adenomas in Patients With Familial Adenomatous Polyposis (PreDuoFAP)


Related eMedicine topics

 Pancreas, Mucinous Cystic Neoplasm

Papillary Tumors

Neoplasms of the Endocrine Pancreas

Colon, Polyps

Hereditary Colorectal Cancer

Colon Cancer, Adenocarcinoma

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Keywords

villous adenoma, tubulovillous adenoma, adenomatous polyps, colonic tumor, colonic neoplasm, papillary adenoma, malignancy, tubular adenoma, tubulovillous adenoma, tubulo-villous adenoma, colonoscopy, adenocarcinomas, rectal cancer, colon cancer, colonic villous adenomas

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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.

Medical Editor

Manoop S Bhutani, MD, FACG, FACP, Professor, Department of Medicine, Division of Gastroenterology, Director, Center for Endoscopic Ultrasound, Co-Director, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch at Galveston
Manoop S Bhutani, MD, FACG, FACP 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

Alex J Mechaber, MD, FACP, 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; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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