Colonic Postpolypectomy Surveillance: What Should Family and Internal Physicians Know in 2024?

A BSTRACT Polyps are a common finding in screening and diagnostic colonoscopy. In general, after adenoma removal, patients should undergo regular endoscopic surveillance related to the adenoma numbers, size, or histopathology. In 2020, three guidelines for postpolypectomy colonoscopy surveillance were published; however, they have similarities and differences. This review aims to emphasize the updated recommendations for colonic surveillance after the removal of colonic adenoma. For example, a 3-year interval is recommended for patients with an adenoma size of ≥10 mm or an adenoma with high-grade dysplasia. There is no consensus in the updated guidelines regarding adenoma <10 mm with villous components. While the United States Preventive Services taskforce (USMSTF) recommends a 3-year interval, the European Society of Gastrointestinal Endoscopy (ESGE) does not consider such histology as a criterion for repeating colonoscopy procedures at such a short interval. The USMSTF recommends surveillance colonoscopies at varying times based on the number and sizes of tubular adenomas found at the time of the patient’s last colonoscopy. The ESGE guidelines related to similar findings do not recommend any specific colonoscopy procedures, instead simply recommending patient participation in routine colorectal cancer screening programs (typically based on fecal immunochemical tests). Family physicians should be familiar with the need for a 3-year interval of colonoscopic surveillance among patients with high-risk polyps and longer intervals or participation in routine screening in patients with low-risk polyps or adenomas.