Colonoscopy done: set the first surveillance interval
Average-risk adults. Use after all polyps are removed and histology is back.
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Post-Polypectomy Surveillance Intervals (USMSTF 2020)
Post-Polypectomy Surveillance Intervals (USMSTF 2020): Colonoscopy done: set the first surveillance interval → Not for hereditary CRC syndrome, IBD, ser...
Pathway Overview
18 steps
Algorithm Steps
18 total
01Start 02Warning Not for hereditary CRC syndrome, IBD, serrated polyposis, CRC or malignant polyp
These intervals are too long for these patients. Age 75 years or more, or major comorbidity: decide with the patient if surveillance still helps. Australia: surveillance is not recommended over 80 years, or at 75-80 years with a Charlson score over 4.
- Lynch syndrome, FAP, MUTYH polyposis, IBD or serrated polyposis syndrome: use the surveillance guideline for that condition.
- Cancer in a polyp (malignant polyp) or past colorectal cancer: follow CRC surveillance and MDT advice.
- Family history of CRC: use the family-history interval if it is shorter.
03Decision Adenoma or SSP 20 mm or larger removed piecemeal?
- If Yes
04End Piecemeal removal, lesion 20 mm or larger: site check at about 6 months
If the scar is clear: repeat 1 year later, then 3 years after that. Residual or recurrent tissue: treat it and check again. Australia: about 6 months; if clear, next at 12-18 months (especially if the lesion was over 40 mm or had HGD).
If No05Decision High-quality exam? Caecum reached, prep adequate, all polyps fully removed
Adequate prep: lesions larger than 5 mm can be seen. Colonoscopist with an adequate adenoma detection rate.
- If Yes
06Decision Main findings (more than one group: use the shortest interval)
Australia (Cancer Council 2018), serrated polyps and adenomas together: count all lesions. 2 small lesions without dysplasia: 5 years. 3-9 small lesions: 3 years. 2-4 lesions with any serrated polyp 10 mm or larger, dysplasia or TSA: 3 years. 5 or more such lesions, or 10 or more in total: 1 year.
- Normal or small HP
07End Normal, or only hyperplastic polyps under 10 mm (20 or fewer): 10 years
Normal: no adenoma, SSP or cancer. More than 20 hyperplastic polyps: check serrated polyposis criteria. Australia: small hyperplastic polyps need no surveillance.
- Adenomas
08Decision Adenomas: number, size and histology
- 1-2 small tubular
09End 1-2 tubular adenomas under 10 mm: 7-10 years
Australia (Cancer Council 2018): 10 years for most, and not sooner than 5 years. Return to the National Bowel Cancer Screening Program (iFOBT) after 4 years is an option; advised for 1-2 adenomas under 6 mm.
- 3-4 small tubular
10End 3-4 tubular adenomas under 10 mm: 3-5 years
Australia: 5 years.
- Advanced or 5-10
11End Adenoma 10 mm or larger, villous, HGD, or 5-10 adenomas under 10 mm: 3 years
Villous includes tubulovillous. HGD: high-grade dysplasia. Assumes complete removal. Australia: 1-2 adenomas, all under 10 mm, with villous features or HGD: 5 years. Any adenoma 10 mm or larger, or 3-4 adenomas with villous features or HGD: 3 years. 5-9 adenomas: 3 years if all tubular under 10 mm; 1 year if any is 10 mm or larger, villous or HGD. En bloc removal of a sessile or laterally spreading lesion 20 mm or larger: about 12 months.
- >10
12End More than 10 adenomas: 1 year, and consider genetic testing
Also consider genetic testing for more than 10 adenomas in a lifetime, based on age and family history. Australia: 10 or more adenomas: 1 year; consider referral to a familial cancer clinic.
- Serrated polyps
13Decision Serrated polyps: type, number and size
SSP: sessile serrated polyp (lesion). TSA: traditional serrated adenoma. Serrated polyposis: 5 or more serrated polyps above the rectum over 5 mm with 2 or more 10 mm or larger, or more than 20 hyperplastic polyps with 5 or more above the rectum: refer.
- 1-2 small SSP
14End 1-2 SSPs under 10 mm: 5-10 years
Australia: 5 years (no dysplasia).
- 3-4 small SSP
15End 3-4 SSPs under 10 mm: 3-5 years
Australia: 3 years.
- Advanced SSP, TSA or 5-10
16End SSP 10 mm or larger, SSP with dysplasia, TSA, or 5-10 SSPs under 10 mm: 3 years
Assumes complete removal. Australia: 1-2 such lesions: 3 years. 3-4 SSPs with any 10 mm or larger or with dysplasia, 3-4 TSAs, or 5 or more small SSPs: 1 year. With a villous or tubulovillous adenoma as well: 3 years if 2 lesions in total, 1 year if 3 or more. En bloc removal of a sessile lesion 20 mm or larger: about 12 months.
- HP >=10 mm
17End Hyperplastic polyp 10 mm or larger: 3-5 years
3 years if there is doubt about SSP versus hyperplastic polyp, prep quality or complete removal; otherwise 5 years. Australia: 3 years.
If No18End Not a high-quality exam: these intervals do not apply
Inadequate prep: repeat colonoscopy within 12 months. Caecum not reached, or removal incomplete or uncertain: plan an early repeat with the endoscopist.
Guideline Source
Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer (2020)
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- First surveillance interval after a colonoscopy in average-risk adults only. Later intervals depend on both the earlier and the latest findings (USMSTF 2020 Table 7).
- Australia: Cancer Council Australia 2018 intervals differ for several groups; each step gives the Australian interval.
- Assumes a high-quality exam: caecum reached, adequate prep, complete polyp removal and a colonoscopist with an adequate adenoma detection rate.
- USMSTF gives no specific advice for adults under 50 years with incidental adenomas or on stopping surveillance in older adults.
Contraindicated Populations
Lynch syndrome or other hereditary CRC syndromeFamilial adenomatous polyposis or MUTYH-associated polyposisInflammatory bowel diseaseSerrated polyposis syndromePersonal history of colorectal cancerMalignant polyp (cancer in a polyp)
Applicable Regions
USAUUKEU
AU: Cancer Council Australia Clinical practice guidelines for surveillance colonoscopy (2018). Intervals differ from USMSTF for several groups; the Australian interval is given in each step.
UK: BSG/ACPGBI/PHE 2020 post-polypectomy surveillance guidelines use different risk groups; follow local guidance.
US: US Multi-Society Task Force 2020 post-polypectomy surveillance recommendations.
Version 2Next review: 2027-09-30
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Frequently Asked Questions
What is the Post-Polypectomy Surveillance Intervals (USMSTF 2020)?
The Post-Polypectomy Surveillance Intervals (USMSTF 2020) is a management clinical algorithm for Colorectal Surgery. It provides a structured decision tree to guide clinical decision-making, based on Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer (2020).
What guideline is the Post-Polypectomy Surveillance Intervals (USMSTF 2020) based on?
This algorithm is based on Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer (2020) (DOI: 10.1053/j.gastro.2019.10.026).
What are the limitations of the Post-Polypectomy Surveillance Intervals (USMSTF 2020)?
Known limitations include: First surveillance interval after a colonoscopy in average-risk adults only. Later intervals depend on both the earlier and the latest findings (USMSTF 2020 Table 7).; Australia: Cancer Council Australia 2018 intervals differ for several groups; each step gives the Australian interval.; Assumes a high-quality exam: caecum reached, adequate prep, complete polyp removal and a colonoscopist with an adequate adenoma detection rate.; USMSTF gives no specific advice for adults under 50 years with incidental adenomas or on stopping surveillance in older adults.. Individual patient factors may require deviation from these recommendations.
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