Optimal Management of Conventional Adenomas in 2026: Current and Evolving Recommendations and Ongoing Controversies.

Abstract

Adenomas are the most common precancerous colorectal lesions detected during colonoscopy. The techniques, endoscopic tools, and recommendations for detection, resection, and surveillance continue to change. This review summarizes current practice regarding detection and resection as well as national and international guidelines for screening, surveillance intervals, and recommended resection techniques, while highlighting areas where recommendations diverge or remain uncertain. We discuss key controversies shaping clinical decision-making, including topics such as the use of all-examination versus screening-specific adenoma detection rate (ADR) thresholds, the impact of computer-aided polyp detection (CADe) on quality benchmarks, and the debated significance of villous features or high-grade dysplasia in guiding follow-up intensity. We use the calendar year 2026 as the reference starting point for optimal adenoma management. In our review, we integrate current guideline recommendations with emerging evidence and ongoing shifts in endoscopic practice, rather than relying on anticipated formal guideline updates. By synthesizing established standards with new data and advancing technologies, this review provides a practical overview to support gastroenterologists in optimizing adenoma management and applying guideline-based care.