Colonic Polyps Follow-up

  • Author: Gregory H Enders, MD, PhD; Chief Editor: Julian Katz, MD   more...
 
Updated: Nov 10, 2011
 

Further Inpatient Care

  • Provide further inpatient care as needed.
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Further Outpatient Care

  • Most gastroenterologists now advocate repeat colonoscopy 5 years following complete removal of a low-risk adenomatous polyp (as defined histologically). Colonoscopy is repeated in 3 years if the polyp has higher-risk features. Repeat colonoscopy may be advised in 3-12 months if the adequacy of polyp removal is a matter of substantial doubt. If no colonic polyps are found at the initial examination, follow-up colonoscopy at approximately 5-year intervals is recommended.
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Inpatient & Outpatient Medications

  • Consider aspirin in select patients with a high risk of colon cancer (and coronary artery disease) and a low risk of gastrointestinal bleeding or hemorrhagic stroke.
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Deterrence/Prevention

  • Currently, no firm guidelines exist regarding the prevention of the development of colonic polyps.
    • Calcium may be modestly protective.
    • Fiber may also have some activity; the best evidence is for cereal fiber.
    • Aspirin may be considered in select patients.
    • Studies have demonstrated that a diet high in antioxidants has no impact on colonic polyp recurrence.
    • In one study, supplementary folate was also found to have no benefit, although this conclusion bears the caveat that the tested population had substantial basal folate intake. Thus, some folate intake may be protective.
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Complications

  • Complications of colonic polyps include bleeding, obstruction, diarrhea, and development of cancer.
  • Complications of polypectomy are uncommon but include bleeding and, rarely, intestinal perforation.
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Prognosis

  • Colonic polyps are curable if removed. If not treated, the patient may develop complications, such as bleeding, and the condition may even be fatal if malignant transformation occurs.
  • Fortunately, colonic polyps grow slowly; cancer development is estimated to usually occur about 10 years after formation of a small colonic polyp.
  • Hereditary nonpolyposis colorectal cancer (HNPCC) is an exception. Progression to cancer appears to be more rapid because of increased genetic instability in the lesion. Patients with HNPCC should undergo screening for colonic polyps at more frequent intervals (every 1-2 y) than patients at average risk.
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Patient Education

  • Patients with a family history of colonic polyps must be aware of the potential benefits of screening for colonic polyps.
  • Patients with FAP must be aware of the potential benefits of screening the upper GI tract and screening family members, beginning at puberty, for the mutant APC gene. Screening is particularly important because of the inevitable development of colon cancer in affected individuals and the benefits associated with colonic resection.
  • Patients with HNPCC should receive colon screening at frequent intervals and are at risk for development of tumors at additional sites, including the uterus and the ovaries in female patients. These patients should consider screening for tumor development at such sites or prophylactic resection.
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Contributor Information and Disclosures
Author

Gregory H Enders, MD, PhD  Associate Professor, Fox Chase Cancer Center

Gregory H Enders, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Gastroenterological Association, American Medical Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Wafik S El-Deiry, MD, PhD  Professor of Medicine, Department of Hematology/Oncology; Co-Program Leader, Radiation Biology Program, Abramson Comprehensive Cancer Center, University of Pennsylvania School of Medicine

Wafik S El-Deiry, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Clinical Investigation, and American Society of Gene Therapy

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

BS Anand, MD  Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

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.

Additional Contributors

Research on colon neoplasia in the author's laboratory has been supported by NIH grant #R01DK64758.

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