Table 1.

Summary of New Evidence for Colon Polyp Surveillance Since 2012

Colonoscopy surveillance category	Evidence
Baseline colonoscopy results
1. No neoplasia	Two large cohort studies demonstrate a reduced risk for incident CRC (HR 0.44) and mortality (0.12) after a normal colonoscopy.9,10 This reduction in risk is durable for at least 10 years.
2. LRA: stronger evidence that this is a low-risk group	a. Cohort study11: fatal CRC was decreased by 25% in patients with LRA compared with the general population, suggesting that this is a low-risk group
	b. US sigmoidoscopy study12 followed over time. Patients with LRA had RR of 1.2 for incident CRC compared with patients with no neoplasia
3. HRA: stronger evidence that this is a high-risk group, and benefits from colonoscopy surveillance	a. Cohort study11: individuals with HRA had higher risk of fatal CRC compared with general population
	b. US sigmoidoscopy study12: HRA associated with higher risk of incident and fatal CRC c. UK study13: individuals with HRA had reduced risk of CRC if they had surveillance compared with those who had no surveillance
4. SSPs	Evidence weak. There is growing evidence that having baseline SSPs is a predictor of detecting large SSPs during surveillance24-26
Colonoscopy surveillance after the first surveillance examination	New evidence that the finding of an HRA at baseline, or at the first surveillance examination, is associated with a higher risk of detecting HRAs on subsequent surveillance examinations20-23

CRC, colorectal cancer; HR, hazard ratio; HRA, high-risk adenoma; LRA, low-risk adenoma; RR, relative risk; SSP, sessile serrated polyp.