Villous Adenoma Follow-up

Updated: Oct 24, 2016
  • Author: Alnoor Ramji, MD, FRCPC; Chief Editor: Burt Cagir, MD, FACS  more...
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Follow-up

Further Outpatient Care

Surveillance colonoscopy (after initial colonoscopy and clearing of polyps) is recommended. Note the following:

  • 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

Potential complications include the following:

  • Hemorrhage

  • Obstruction

  • Bowel torsion

  • Malignant transformation

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Prognosis

Transformation to malignancy is a primary consideration in villous adenomas. Note the following:

  • 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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