Download PDF
Endoscopy 2003; 35(8): S35-S40
DOI: 10.1055/s-2003-41529
Colon
© Georg Thieme Verlag Stuttgart · New York

Update on Colorectal Polyps: Management and Follow-Up Surveillance

J.  H.  Bond1
  • 1 Minneapolis Veterans Affairs Medical Center, University of Minnesota
Further Information

Publication History

Publication Date:
20 August 2003 (online)

Also available at
    Permissions and Reprints

Available scientific data and considerable clinical experience indicate that over 95 % of colorectal cancers arise in benign adenomatous polyps that develop and advance very slowly over many years. Interruption of this adenoma–carcinoma sequence by finding and resecting polyps is a highly effective method of preventing colorectal cancer. Colonoscopy is the procedure of choice for both the diagnosis and resection of colorectal polyps. Patients who have had colonoscopic resection of adenomas, and in some cases their close relatives, are at a higher than average risk for developing future polyps and cancer, and likely will benefit from periodic follow-up colonoscopic surveillance. This surveillance should to be tailored to the perceived risk of each individual case depending on the features of the resected adenomas and other patient factors such as family history. Widespread adoption of current polyp guideline recommendations would be highly protective and yet would conserve medical resources.

References

  • 1 Morson B C. Evolution of cancer of the colon and rectum.  Cancer. 1974;  34 845-849
    PubMedGoogle Scholar
  • 2 Bond J H. Clinical evidence for the adenoma–carcinoma sequence, and the management of patients with colorectal adenomas.  Semin Gastrointest Dis. 2000;  11 176-184
    PubMedGoogle Scholar
  • 3 Muto T, Bussy H JR, Morson B C. The evolution of cancer of the colon and rectum.  Cancer. 1975;  36 2251-2270
    CrossrefPubMedGoogle Scholar
  • 4 Hamilton S R. Pathologic features of colorectal cancer. In: Cohen AM, Winawer SJ (ed) Cancer of the Colon, Rectum and Anus. New York; McGraw-Hill 1995: 189-196
    Google Scholar
  • 5 Burt R W, Peterson G M. Familial colorectal cancer: Diagnosis and Management. In: Young GP, Rozen P, Levin B (ed) Prevention and Early Detection of Colorectal Cancer. London; WB Saunders 1996: 171-194
    Google Scholar
  • 6 Chu D Z, Giacco G, Martin R G. et al . The significance of synchronous carcinoma and polyps in the colon and rectum.  Cancer. 1986;  57 445-450
    PubMedGoogle Scholar
  • 7 Fearon E R. Molecular genetic studies of the adenoma–carcinoma sequence.  Adv Intern Med. 1994;  39 123-147
    PubMedGoogle Scholar
  • 8 Correa P. Epidemiology of polyps and cancer in the human intestine.  Gastroenterology. 1979;  77 1245-1251
    PubMedGoogle Scholar
  • 9 Hoff G, Foerster A, Vatn M H. et al . Epdemiology of polyps in the rectum and colon: Recovery and evaluation of unresected polyps 2 years after detection.  Scand J Gastroenterol. 1986;  21 853-862
    CrossrefPubMedGoogle Scholar
  • 10 Winawer S J, Zauber A, Diaz R. et al . Temporal sequence of evolving colorectal cancer from the normal colon.  Gastrointest Endosc. 1987;  33 167 (abstract)
    PubMedGoogle Scholar
  • 11 Stryker S J, Wolff B G, Culp C E. et al . Natural history of untreated colonic polyps.  Gastroenterology. 1987;  93 1009-1013
    CrossrefPubMedGoogle Scholar
  • 12 Gilbertsen V A, Nelms J M. The prevention of invasive cancer of the rectum.  Cancer. 1978;  41 1137-1139
    PubMedGoogle Scholar
  • 13 Selby J V, Friedman G D, Quesenberry C P. et al . A case–control study of screening sigmoidoscopy and mortality from colorectal cancer.  N Engl J Med. l992;  326 653-657
    PubMedGoogle Scholar
  • 14 Newcomb P A, Norfleet R G, Storer B E. et al . Screening sigmoidoscopy and colorectal cancer mortality.  J Natl Cancer Inst. 1992;  84 1572-1575
    CrossrefPubMedGoogle Scholar
  • 15 Muller A D, Sonnenberg A. Prevention of colorectal cancer by flexible endoscopy and polypectomy: A case–control study of 32, 702 veterans.  Ann Intern Med. 1995;  123 904-910
    CrossrefPubMedGoogle Scholar
  • 16 Winawer S J, Zauber A G, Ho M N. et al . Prevention of colorectal cancer by colonoscopic polypectomy.  N Engl J Med. 1993;  329 1977-1983
    CrossrefPubMedGoogle Scholar
  • 17 This-Evensen E, Hoff G S, Sauar F. et al . Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer.  Telemark Polyp Study I. Scand J Gastroenterol. 1999;  34 414-420
    PubMedGoogle Scholar
  • 18 Citarda F, Tomaselli G, Capocaccia R. et al . Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence.  Gut. 2001;  48 812-815
    CrossrefPubMedGoogle Scholar
  • 19 Zauber A G, Winawer S J, Loeve F. et al, for the National Polyp Study Group . Effect of initial polypectomy versus surveillance polypectomy on colorectal cancer incidence reduction: Micro-simulation modeling of National Polyp Study data.  Gastroenterology. 2000;  118 A187(abstract)
    PubMedGoogle Scholar
  • 20 Hogen W J, Stweart E T, Geenen J E. et al . A prospective comparison of the accuracy of colonoscopy vs. air-contrast barium enema for detection of colonic polypoid lesions.  Gastrointest Endosc. 1977;  23 230 (abstract)
    PubMedGoogle Scholar
  • 21 Winawer S J, Stewart E T, Zauber A G, Bond J H. et al . A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy.  N Engl J Med. 2000;  342 1766-72
    CrossrefPubMedGoogle Scholar
  • 22 Hixson L J, Fennerty M B, Sampliner R E. et al . Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps.  Gastrointest Endosc. 1991;  37 125-127
    CrossrefPubMedGoogle Scholar
  • 23 Rex D K, Cutler C S, Lemmel G T, Rahmani E Y, Clark D W, Helper D J. et al . Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
    CrossrefPubMedGoogle Scholar
  • 24 Rankin G B. Indications, contraindications and complications of colonoscopy. In: Sivak MV (ed) Gastrointestinal Endoscopy. Philadelphia; WB Saunders 1987: 873-878
    Google Scholar
  • 25 Dodd G D. The radiologic diagnosis of carcinoma of the colon in gastrointestinal cancer. In: Stroehlein JR, Romsodahl MM (ed) Gastrointestinal Cancer. New York; Raven Press 1981: 327-344
    Google Scholar
  • 26 Fenlon H M, Nunes D P, Schroy P C. et al . A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps.  N Engl J Med . 1999;  341 1496-1503
    CrossrefPubMedGoogle Scholar
  • 27 Fletcher J G, Johnson C D, Welch T J. et al . Optimization of CT colonography technique: prospective trial in 180 patients.  Radiology. 2000;  216 704-711
    CrossrefPubMedGoogle Scholar
  • 28 Yee J, Akerkar G A, Hung R K. et al . Colorectal neoplasia: Performance characteristics of CT colonography for detection in 300 patients.  Radiology. 2001;  219 685-692
    PubMedGoogle Scholar
  • 29 Cotton P B, Durkalski V L, Yuko Y P. et al . Comparison of virtual colonoscopy and colonoscopy in the detection of polyps/masses.  Gastrointest Endosc. 2002;  55 AB98 (abstract)
    PubMedGoogle Scholar
  • 30 Rex D K, Smith J J, Ulbright T M. et al . Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects.  Gastroenterology. 1992;  102 317-319
    PubMedGoogle Scholar
  • 31 Waye J D. Polypectomy techniques. In: Raskin JB, Nord HJ (ed) Colonoscopy: Principles and Techniques. New York; Igaku-Shoin 1995: 293-316
    Google Scholar
  • 32 Bond J H. Clinical relevance of the small colonic polyp.  Endoscopy. 2001;  33 454-57
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Binmoeller K F, Bohnacker S, Seiferet H. et al . Endoscopic snare excision of ”giant“ colorectal polyps.  Gastrointest Endosc. 1996;  43 183-188
    CrossrefPubMedGoogle Scholar
  • 34 Shatz B A, Weinstock , LB , Swanson P E. et al . Long-term safety of India ink tattoos in the colon.  Gastrointest Endosc. 1997;  45 153-156
    PubMedGoogle Scholar
  • 35 Coutsoftides T, Sivak M V, Jr., Benjamin S P. et al . Colonoscopy and the management of polyps with invasive carcinoma.  Ann Surg. 1978;  188 638-641
    PubMedGoogle Scholar
  • 36 Cranley J P, Petras R E, Carey W D. et al . When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma?.  Gastroenterology. 1986;  91 419-427
    PubMedGoogle Scholar
  • 37 Coverlizza S, Risio M, Ferrari A. et al . Colorectal adenomas containing invasive carcinoma: Pathologic assessment of lymph node metastatic potential.  Cancer. 1989;  64 1937-1947
    CrossrefPubMedGoogle Scholar
  • 38 Winawer S J, Zauber A G, Gerdes H. et al . Risk of colorectal cancer in the families of patients with adenomatous polyps.  N Engl J Med. l996;  334 82-87
    PubMedGoogle Scholar
  • 39 Ahsan H, Neugut A I, Garbowski G C. et al . Family history of colorectal adenomatous polyps and increased risk for colorectal cancer.  Ann Intern Med. l998;  128 900-905
    PubMedGoogle Scholar
  • 40 Bond J H. for the Practice Parameters Committee of the American College of Gastroenterology . Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps.  Am J Gastroenterol. 2000;  95 3053-3063
    CrossrefPubMedGoogle Scholar
  • 41 Winawer , SJ , Fletcher , R , Rex D K, Bond J H. et al . Colorectal cancer screening and surveillance: Clinical guidelines and rationale – update based on new evidence.  Gastroenterology. 2003;  124 544-560
    CrossrefPubMedGoogle Scholar
  • 42 Spencer R J, Melton L J, Ready R L. et al . Treatment of small colorectal polyps: a population-based study of risk of subsequent carcinoma.  Mayo Clin Proc. 1984;  59 305-310
    PubMedGoogle Scholar
  • 43 Lotfi A M, Spencer R J, Illstrup D M. et al . Colorectal polyps and the risk of subsequent carcinoma.  Mayo Clin Proc. l986;  61 337-343
    PubMedGoogle Scholar
  • 44 Atkin W S, Morson B C, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas.  N Engl J Med. 1992;  326 658-662
    CrossrefPubMedGoogle Scholar
  • 45 Winawer S H, Zauber , AG , O’Brien M J. et al . The National Polyp Study: design, methods, and characteristics of patients with newly diagnosed polyps.  Cancer. 1992;  70 (Suppl) 236-1245
    PubMedGoogle Scholar
  • 46 Winawer S J, Zauber A G, O’Brien M J. et al . Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps.  N Engl J Med. 1993;  328 901-906
    CrossrefPubMedGoogle Scholar
  • 47 van Stolk R U, Beck G J, Baron J A. et al . Adenoma characteristics at first colonoscopy as predictors of adenoma recurrence and characteristics at follow-up.  Gastroenterology. 1998;  115 13-18
    PubMedGoogle Scholar
  • 48 Kairasp C, Noshirwani M D, van Stolk R U. et al . Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy.  Gastrointest Endosc. 2000;  51 422-427
    PubMedGoogle Scholar
  • 49 Mysliwiec P A, Pfeiffer R, Lanza E, Schatzkin A. The Polyp Prevention Study. Characteristics of baseline colorectal adenomas as predictors of adenoma recurrence.  Gastroenterology. 2002;  122 A570
    PubMedGoogle Scholar
  • 50 Lieberman D A. Cost-effectiveness model for colon cancer screening.  Gastroenterology. 1995;  109 1781-1790
    CrossrefPubMedGoogle Scholar

Prof. J. H. Bond, M. D.

Gastroenterology Section (111D) · VA Medical Center

One Veterans Drive · Minneapolis · MN 554l7 · USA

Fax: +1-612-725-2248

Email: john.bond@med.va.gov