Post-Polypectomy Surveillance Recommendations Summary

These evidence-based recommendations are from ColonCancerCheck, Ontario’s colorectal cancer screening program.

Surveillance recommendations are organized by initial colonoscopy findings. Recommendations may be adjusted according to the findings of each subsequent colonoscopy.

Also available as a handout: Recommendation for Post-Polypectomy Surveillance.

Also see: Post-Polypectomy Surveillance Frequently Asked Questions for Healthcare Providers

Select the initial colonoscopy findings to review the recommendation.

No polyps or hyperplastic polyp(s) in the rectum or sigmoid

Return to average risk screening with the fecal immunochemical test (FIT) 10 years after the initial colonoscopy.

1 or 2 low risk adenoma(s)

Return to screening with the fecal immunochemical test (FIT) 5 years after the initial colonoscopy.

High risk adenoma(s)

Surveillance colonoscopy 3 years after the initial colonoscopy.

Subsequent colonoscopy

The findings of the surveillance colonoscopy will influence the subsequent surveillance interval, as follows:

If no polyps, hyperplastic polyp(s) in the rectum or sigmoid colon, or low risk adenoma(s) are found, the person should have a colonoscopy in 5 years.
If high risk adenoma(s) are found, the person should have a colonoscopy in 3 years.

More than 10 adenomas

Clearing colonoscopy within 1 year of the initial colonoscopy
Genetic assessment for familial adenomatous polyposis (FAP) syndromes

Subsequent colonoscopy

The surveillance interval will depend on the results of the genetic assessment and whether the colon is cleared of polyps.
If there is no FAP and after the colon is cleared, the surveillance recommendation is colonoscopy within 3 years of the clearing colonoscopy.

Sessile serrated adenoma(s) less than 10 millimeters without dysplasia

Repeat colonoscopy 5 years after the initial colonoscopy.

Subsequent colonoscopy

At the endoscopist’s discretion.
Sessile serrated polyps and traditional serrated adenomas require continued surveillance, but there is currently insufficient evidence to make specific recommendations on subsequent surveillance intervals.

Sessile serrated adenoma(s) 10 millimeters or greater without dysplasia, sessile serrated adenoma(s) with dysplasia, or traditional serrated adenoma(s)

Repeat colonoscopy 3 years after the initial colonoscopy.

Subsequent colonoscopy

At the endoscopist’s discretion.
Sessile serrated polyps and traditional serrated adenomas require continued surveillance, but there is currently insufficient evidence to make specific recommendations on subsequent surveillance intervals.

Large sessile polyp removed piecemeal

Repeat colonoscopy to check the polypectomy site within 6 months of the initial colonoscopy.

Subsequent colonoscopy

At the endoscopist’s discretion.
Sessile serrated polyps and traditional serrated adenomas require continued surveillance, but there is currently insufficient evidence to make specific recommendations on subsequent surveillance intervals.

Serrated polyposis syndrome

Colonoscopy 1 year after the initial colonoscopy.

Subsequent colonoscopy

Within 1 to 2 years at the endoscopist’s discretion.

Background

ColonCancerCheck’s post-polypectomy recommendations are adapted from Canadian,^[1] American^[2] and European^[3] colonoscopy surveillance guidelines and informed by an additional systematic review on the risk of developing high risk adenomas, colorectal cancer or dying from colorectal cancer in people with low risk adenomas found during an initial colonoscopy.^[4]

The recommendations are based on the size and histology of the most advanced lesion and assume a high-quality colonoscopy (i.e., adequate bowel preparation to detect polyps 5 mm in size, complete procedure to cecum, careful examination of the colonic mucosa).

The recall interval following a normal colonoscopy for people with a family history of colorectal cancer in a first-degree relative should be based on family history or surveillance recommendations, whichever interval is shorter.

Find out more about how these recommendations were developed and their application at Post-Polypectomy Surveillance Recommendations Frequently Asked Questions for Healthcare Providers.

Glossary

Low risk adenomas: 1 to 2 tubular adenoma(s) less than 10 millimeters in diameter with no high-grade dysplasia. All adenomas are dysplastic by definition and low risk adenomas only contain low grade dysplasia.

High risk adenomas (also called advanced adenomas): Tubular adenoma 10 millimeters in diameter or greater, 3 or more adenomas, adenoma(s) with villous histology or adenoma with high-grade dysplasia.

Serrated adenomas: Either sessile serrated adenomas (also called “sessile serrated polyps” or “sessile serrated adenoma/polyp”) or traditional serrated adenomas. Most serrated polyps will not have any dysplasia; serrated polyps with dysplasia are considered advanced. Traditional serrated adenomas are uncommon and are often protuberant and left-sided.^[5]

Serrated polyposis syndrome: At least 5 serrated polyps proximal to the sigmoid colon, with 2 or more being more than 10 millimeters, or any number of serrated polyps proximal to the sigmoid colon in someone who has a first-degree relative with serrated polyposis, or 20 or more serrated polyps of any size distributed throughout the colon.^[6]

Clearing colonoscopy: Repeat procedure performed to ensure that all neoplasia has been removed from the colon. A clearing colonoscopy is performed earlier than a surveillance colonoscopy.

Hyperplastic polyps: hyperplastic polyps are very common and usually occur as diminutive (less than 5 millimeters) non-dysplastic polyps in the rectum and sigmoid colon. These polyps are not associated with an increased risk of developing colorectal cancer and are therefore not considered to be screen-relevant lesions.