Polyp Guideline: Diagnosis, Treatment, and Surveillance for Patients with Nonfamilial Colorectal Polyps*

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Abstract
To outline the preferable approach to the management of patients with nonfamilial colorectal polyps. The human subject English language literature for the past 15 years, searched using MEDLINE and the terms "polyp-," "adenoma-," and "polypectomy-colorectal." The titles and abstracts of all pertinent articles were reviewed. All randomized controlled trials and large case-control and cohort studies related to colorectal polyps were reviewed in depth. Evidence was evaluated along a hierarchy with randomized controlled trials receiving the greatest weight. Conclusions and recommendations were reviewed by a large group of experts in gastroenterology, radiology, and pathology and were circulated for comment to primary care medical societies. Most patients with polyps should undergo colonoscopy to excise the polyp and search for synchronous neoplasms. Small polyps (< 0.5 cm) require individualization. A hyperplastic polyp found during proctosigmoidoscopy is not an indication for colonoscopy. Large sessile polyps require careful follow-up to ensure complete resection. The need for further treatment of a resected polyp with invasive carcinoma depends on several well-defined clinical and pathologic criteria. Follow-up surveillance after polypectomy should be tailored to the individual risk assessment for each patient. Initial follow-up should be performed at 3 years for most postpolypectomy patients. After one negative result of a 3-year examination, the interval can be increased to 5 years. Patients with one small tubular adenoma do not have an increased risk for cancer, and therefore follow-up surveillance may not be indicated. Adoption of these recommendations should substantially reduce the cost of postpolypectomy surveillance and of screening for colorectal cancer.

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