What are the guidelines for postpolypectomy surveillance?

Updated: Mar 18, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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A 2020 update of US Multi-Society Task Force on Colorectal Cancer guidelines provides recommendations on postpolypectomy surveillance. The recommendations assume high-quality baseline colonoscopy, defined as meeting all the following criteria: [17]

  • Adequate bowel preparation
  • Performance by a colonoscopist with adequate adenoma detection rate
  • Complete examination to the cecum
  • Attention to complete polyp excision

Screening colonoscopy findings and recommended scheduling of surveillance colonoscopy are as follows [17] :

  • Normal colonoscopy, or < 20 hyperplastic polyps < 10 mm: 10 years
  • 1–2 adenomas < 10 mm: 7–10 years
  • 3–4 adenomas < 10 mm: 3–5 years
  • 5–10 adenomas, adenoma ≥10 mm, or adenoma with villous component or high-grade dysplasia: 3 years
  • More than 10 adenomas: 1 year, with consideration for genetic testing based on adenoma burden, age, and family history
  • Piecemeal resection of adenoma ≥20 mm: 6 months, then 1 year later, then 3 years after the second examination
  • 1–2 sessile serrated polyps (SSPs) < 10 mm: 5–10 years
  • 3–4 SSPs < 10 mm or hyperplastic polyp ≥10 mm: 3–5 years
  • 5–10 SSPs, SSP ≥10 mm, SSP with dysplasia, or traditional serrated adenoma:  3 years

In 2020, the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) released joint post-polypectomy and post–colorectal cancer resection surveillance guidelines.  According to the guidelines, the criteria for high-risk for future colorectal cancer (CRC) following polypectomy comprise either of the following [18] :

  • Two or more premalignant polyps, including at least one advanced colorectal polyp (defined as a serrated polyp at least 10 mm in size or containing any grade of dysplasia, or an adenoma at least 10 mm in size or containing high-grade dysplasia);  or
  • Five or more premalignant polyps

Patients who meet the high-risk criteria should undergo a single surveillance colonoscopy at 3 years.  Patients who have undergone CRC resection should have a colonoscopy at 1 year post-surgery and every 3 years thereafter. [18]

Patients who do not meet high-risk criteria postpolypectomy should participate in national bowel screening when invited. For patients who are more than 10 years younger than the national bowel screening lower age limit, colonoscopy may be considered after 5 or 10 years and individualized to age and other risk factors. [18]

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