Summary of current guidelines for surveillance intervals after endoscopic removal of serrated polyps
| Histology | Size | Number | Location | Organization | ||
|---|---|---|---|---|---|---|
| International Serrated Lesions Expert Panel (9) | CAG Working Group (7) | United States MSTF (8) | ||||
| HP | < 10 mm | Any | Rectosigmoid | 10 yr | NS | 10 yr |
| HP | < 5 mm | < 3 | Proximal to sigmoid | 10 yr | NR | NR |
| HP | > 5 mm | > 1 | Proximal to sigmoid | 5 yr | NR | NR |
| HP | Any | > 4 | Proximal to sigmoid | 5 yr | NR | NR |
| HP | > 10 mm | Any | Proximal to sigmoid | 5 yr | NR | NR |
| SSL | < 10 mm | < 3 | Any | 5 yr | 5 yr | 5 yr |
| SSL | < 10 mm | > 3 | Any | 3 yr | 3 yr | 3 yr |
| SSL | > 10 mm | > 1 | Any | 3 yr | 3 yr | 3 yr |
| SSL with dysplasia | Any | Any | Any | 1–3 yr* | 3 yr | 3 yr |
| TSA | < 10 mm | < 3 | Any | 5 yr | 3 yr | 3 yr |
| TSA | < 10 mm | > 3 | Any | 3 yr | 3 yr | 3 yr |
| TSA | > 10 mm | 1 | Any | 3 yr | 3 yr | 3 yr |
| SPS | See details† | see details† | see details† | 1 yr‡ | 1 yr | 1 yr |
| Adenomatous polyp | < 10 mm | < 3 | Any | NR | 5–10 yr | 5–10 yr |
| Adenomatous polyp | < 10 mm | > 3 | Any | NR | 3 yr | 3 yr |
| Adenomatous polyp | > 10 mm | > 1 | Any | NR | 1 to 3 yr§ | 3 yr |
| Adenomatous polyp with HGD or villous features | Any | Any | Any | NR | 3 yr | 3 yr |
CAG = Canadian Association of Gastroenterology; HGD = high-grade dysplasia; HP = hyperplastic polyp; MSTF = Multisite Task Force; NR = no recommendation; NS = no surveillance; SPS = serrated polyposis syndrome; SSL = sessile serrated lesion; TSA = traditional serrated adenoma; WHO = World Health Organization.
↵* International expert panel guideline states that depending on the size of the lesion, the confidence in complete endoscopic resection and other associated lesions, intervals shorter than 3 yr can be considered.
↵† The WHO 2019 diagnostic criteria define SPS as presence of any 1 of these features: presence of at least 5 SPs proximal to the sigmoid colon, all > 5 mm in size with at least 2 > 10 mm in size; presence of > 20 SPs of any size distributed throughout the colon, with > 5 being proximal to the rectum.
↵‡ Annual colonoscopy with intent to clear the proximal colon of all SPs or all SPs with size ≥ 5 mm. If subsequent examination indicates loss of control or progressive control of the polyp burden, then the surveillance interval can be altered.
↵§ Canadian guideline indicates if > 10 adenomatous polyps were found then follow-up colonoscopy should be performed in 1 yr.