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Colon Polyps
Diagnosis/Definition
A polyp is any mucosal projection, but only adenomas need to be referred for colonoscopy. (Hyperplastic polyps are considered “normal”).
Initial Diagnosis and Management
- If seen at the time of sigmoidoscopy examination, polyps <8 mm should be biopsied (the open biopsy forceps is 7-8 mm) to determine histology.
- Barium enema is usually not indicated for the diagnosis or follow-up of a polyp.
Ongoing Management and Objectives
Periodic follow-up as indicated below.
Indications for Specialty Care Referral
Adenomatous polyps: Refer all adenomas found by flex-sig.
Colonoscopy in 5 years for 1-2 tubular adenomas < 1 cm in size.
Colonoscopy in 3 years if polyps are > 1 cm, villous histology or numerous (3 or more).
With history of “polyps”, type unknown and path can’t be obtained, assume adenomas.
Refer all patients with polyps > 8 mm or mass by flex-sig, even without being biopsied (assumed adenoma, possible cancer if mass present).
All polyps or masses found by barium enema need referral for colonoscopy.
Surveillance after colon cancer resection: Colonoscopy 1 year after colectomy, then every 3 years but interval can be 5 years if last colonoscopy exam was normal.
History of adenomas = colonoscopy every 5 years.
Hyperplastic polyps do NOT need referral.
Criteria for Return to Primary Care
Completion of colonoscopy.
