US multi-society task force recommendations for post-colonoscopy follow-up in average-risk adults with serrated polyps*

Baseline colonoscopy finding	Recommended interval for surveillance colonoscopy	Strength of recommendation	Quality of evidence
≤20 HPs in rectum or sigmoid colon <10 mm^¶	10 years^Δ	Strong	Moderate
≤20 HPs proximal to sigmoid colon <10 mm^¶	10 years	Weak	Very low
1 to 2 SSPs <10 mm	5 to 10 years	Weak	Very low
3 to 4 SSPs <10 mm	3 to 5 years	Weak	Very low
5 to 10 SSPs <10 mm	3 years	Weak	Very low
SSP ≥10 mm	3 years	Weak	Very low
SSP with dysplasia^◊	3 years	Weak	Very low
HP ≥10 mm	3 to 5 years^§	Weak	Very low
TSA	3 years	Weak	Very low
Piecemeal resection of SSP ≥20 mm	6 months	Strong	Moderate^¥

SSP: sessile serrated polyp; HP: hyperplastic polyp; TSA: traditional serrated adenoma; CRC: colorectal cancer.
* All recommendations assume examination complete to cecum with bowel preparation adequate to detect lesions >5 mm in size; recommendations do not apply to individuals with a hereditary CRC syndrome, personal history of inflammatory bowel disease, personal history of hereditary cancer syndrome, serrated polyposis syndrome, or malignant polyp, personal history of CRC, or family history of CRC, and must be judiciously applied to individuals with a personal or family history of CRC, favoring the shortest indicated interval based on either history or polyp findings.
¶ Patients with cumulative >20 hyperplastic polyps distributed throughout the colon, with at least 5 being proximal to the rectum, as well as those with 5 serrated polyps proximal to the rectum >5 mm, with at least two ≥10 mm meet criteria for serrated polyposis syndrome and may require specialized management.
Δ Follow-up may be with colonoscopy or other screening modality for average risk individuals.
◊ Assumes high confidence of complete resection.
§ A 3-year follow-up interval is favored if concern about consistency in distinction between SSP and HP locally, bowel preparation, or complete excision, whereas a 5-year interval is favored if low concerns for consistency in distinction between SSP and HP locally, adequate bowel preparation, and confident complete excision.
¥ Refer to US Multi-Society Task Force recommendations for endoscopic removal of colorectal lesions.

From: Gupta S, Lieberman D, Anderson JC, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2020. DOI: 10.14309/ajg.0000000000000544. Copyright © 2020 the American College of Gastroenterology, the AGA Institute, and the American Society for Gastrointestinal Endoscopy. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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