Kolonda Polip ve Adenom Takibi

- Adenomatöz polip saptandıysa : tüm kolon görülmelidir.kolonun tamamı görülmediyse kolonoskopi tekrarlanmalı.

Düşük Riskli Polipler :

Sayıca 1-2 adet , boyutları <10 mm ve tubuler adenom/ düşük derece displazi olan polipler --> rutin takibi ne gerektiriyorsa (kabaca 5-10 yıl sonra kolonoskopi tekrarı)

Orta derecede riskli polipler :

Sayıca 3-4 adet veya en az bir tanesi 10-20 mm boyutlarında veya villoz adenom / yüksek derece displazi olan polipler -->

3 yıl sonra kolonoskopi tekrarı 

Yüksek derecede riskli polipler :

Sayıca 5 ve daha fazla sayıda veya en az bir tanesinin boyutu >20 mm olan polipler--> 1 yıl sonra kolonoskopi tekrarı 

Serrated poliplerin takibi : 

- Sesil serrated polip <10 mm ve displazi yok ise 5 yıl sonra 

- Sesil serrated polip >10 mm ve boyutundan bağımsız displazi içeriyorsa 3 yıl sonra kolonoskopi tekrarı uygundur.

Hamartomatöz Polipler: 

Juvenile polyps Juvenile polyps resulting in lower gastrointestinal bleeding or prolapse through the rectum require polypectomy. Asymptomatic patients do not require treatment.

Peutz-Jeghers polyps The polyps are usually benign, but may grow progressively and produce symptoms or undergo malignant transformation. Patients with PJS are at increased risk of both gastrointestinal (gastric, small bowel, colon, pancreas) and nongastrointestinal cancers including breast cancer.

Cronkhite-Canada syndrome The polyps are hamartomas and do not appear neoplastic pathologically. 

Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome 

Hyperplastic polyps : In patients with <20 hyperplastic polyps that are <10 mm, surveillance colonoscopy is recommended in 10 years

In patients with hyperplastic polyps ≥10 mm, a repeat colonoscopy is suggested in three to five years

Sessile serrated polyps and traditional serrated adenomas(TSA)

SSPs are managed clinically like adenomatous polyps and complete excision is recommended

•In individuals with one to two SSPs <10 mm in size with no dysplasia, we perform surveillance colonoscopy in 5 to 10 years. (See 'Patients without advanced adenomas' below.)

•In individuals with three to four SSPs <10 mm, surveillance colonoscopy is repeated in three to five years. In individuals with 5 to 10 SSPs <10 mm, surveillance colonoscopy is performed in three years.

•Individuals with SSP ≥10 mm, a SSP with dysplasia, or TSA are managed as advanced adenomas with a first surveillance colonoscopy in three years.

ADENOMATOUS POLYPS

Adenomas should be resected completely.

Patients with advanced adenomas (≥10 mm, villous histology, or high grade dysplasia) — An advanced adenomas is defined as any one of the following:

•Tubular adenoma ≥10 mm or

•Adenoma with villous histology, or high-grade dysplasia

First surveillance – Individuals with an advanced adenoma should undergo a first surveillance colonoscopy in three years (table 4) [23]. For adenomas ≥20 mm that have been resected piecemeal, repeat colonoscopy should be performed at six months.

●Subsequent surveillance – 

•If no adenomas are found on the first surveillance colonoscopy, the next surveillance colonoscopy should be performed in five years. 

•If the first surveillance colonoscopy is normal (no adenomas, SSP, hyperplastic polyp ≥10 mm, or CRC) or if only one to two tubular adenomas are detected, the next surveillance colonoscopy should be performed at five years.

•If three to four tubular adenomas <10 mm are detected, the next surveillance colonoscopy should be performed in three to five years.

•If an advanced adenoma is detected or 5 to 10 adenomas <10 mm are detected, the next surveillance colonoscopy should be performed in three years.

Patients without advanced adenomas — If only one or two small (<10 mm) tubular adenomas are found on baseline colonoscopy, the first surveillance colonoscopy should be performed in 7 to 10 years

●If no adenomas are found on the first surveillance colonoscopy, the next surveillance colonoscopy should be performed in 10 years in the absence of other factors associated with increased risk for colorectal cancer (eg, colorectal cancer or a high-risk adenoma in a first-degree relative prior to age 60 years or in two first-degree relatives regardless of age). 

●If one to two small adenomas are detected, the next surveillance colonoscopy should be performed in 7 to 10 years.

●If three to four small adenomas are detected, the next surveillance colonoscopy should be performed in three to five years.

●If >10 adenomas are detected on single examination, surveillance colonoscopy should be performed in one year.

●Patients with >10 adenomas on a single examination or >10 cumulative adenomas in their lifetime should also be evaluated for a hereditary colorectal cancer syndrome 

●If an advanced adenoma is detected or if an individual has 5 to 10 low-risk adenomas, the next surveillance colonoscopy should be performed in three years. 

* Fibroblastic polyps :These polyps are believed to be benign, and surveillance is not recommended.