Guidelines for Colonoscopy Surveillance

Colonoscopies are the most common form of colorectal cancer screening in the United States. These screenings allow us to find and to remove polyps or adenomas—small, typically benign growths. The size, type, and frequency of these polyps are indicators for a patient’s risk for cancer. The guidelines are recommendations for follow-up colonoscopy screenings after the first screening. The intervals between colonoscopies are designed for efficiency and effectiveness. Repeating colonoscopies too often causes unnecessary cost and risk of procedures for the patient, but too few colonoscopies over time can lead to higher risk patients developing colorectal cancer. The Table indicates the type, size, and frequency of the growth along with the length of the interval in years between each colonoscopy recommended by the guidelines. Keep in mind that there are other symptoms that may call for colonoscopies within the interval period.



Table: Recommended Screening Intervals



No polyps


No adenomas, small (< 10mm) polyps


1-2 tubular small (< 10mm) adenomas


3-10 adenomas


More than 10 adenomas

< 3

1 or more tubular large  (³ 10mm) adenomas


1 or more villous adenomas


1 or more adenomas with HGD


Small (< 10mm) sessile serrated polyps


Large (³ 10mm) sessile serrated polyps


Serrated polyposis syndrome


Lieberman, David, et. al. “Guidelines for Colonoscopy Surveillance After Screening and Polypectomy.” Gastroenterology 143 (2012): 844-857.

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