BJ Hoskins et al.  J Gastroenterol Hepatol. 2026 Apr 24. Open Access! Incidental Colorectal Adenomas in Adolescents: Clinical Management, Genetic Evaluation, and Surveillance (Review article)

Key points:

• “Although most isolated colorectal adenomas identified in adolescents are ultimately sporadic, their rarity at this age justifies a lower threshold for genetic evaluation—without routine shortening of surveillance intervals in the absence of hereditary disease”
• “Current guidelines recommend initiating upper gastrointestinal surveillance at age 20–25 years for FAP and attenuated FAP [17]. Notably, a meta-analysis reported that 42% of children with FAP who underwent EGD had duodenal adenomas…, supporting the biological rationale for upper gastrointestinal screening once a polyposis syndrome is identified”
• Table 1 lists polyposis syndromes that can be associated with isolated adenomas in adolescents
• “All visible adenomas should be completely removed when technically feasible'”

My take: This review provides useful guidance when identifying an adenomatous polyp in the pediatric age group.

Related blog posts:

• ESPGHAN Juvenile Polyposis Position Paper While the polyps described are not tubular adenomatous polyps, it is noted that guidelines in adults recommend followup in 5-10 years for a single (non-serrated) adenomatous polyp (Polyps: Clinical Decision Tool).
• Updated Guidelines on Genetic Testing/management for Hereditary GI Cancer Syndromes
• Surprising Genetic Mutations in Polyposis Study
• Polyposis in Pediatric Patients -Review
• Consensus guidelines after polypectomy | gutsandgrowth
• Adenoma Detection Rate: Life or Death Quality Measure
• Cold vs Hot Polypectomy for Small Polyps (2023)
• How to Do a Colonoscopic Polypectomy & U.S. COVID-19 Tracker
• How Benign Are Juvenile Polyps?
• Adverse Events Following Pediatric Endoscopy -Previously Underestimated

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