Table 5.

USMSTF 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 Hyperplastic polyps in rectum or sigmoid colon < 10mm	10 years###	Strong	Moderate
≤ 20 Hyperplastic polyps proximal to sigmoid colon < 10mm	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
Hyperplastic polyp ≥ 10 mm	3 to 5 years#	Weak	Very low
Traditional serrated adenoma	3 years	Weak	Very low
Piecemeal resection of SSP ≥20 mm	6 months	Strong	Moderate##

^*All recommendations assume exam complete to cecum with bowel preparation adequate to detect lesions >5mm 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, 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

^**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.

^##See USMSTF recommendations for endoscopic removal of colorectal lesions⁶⁷

^###Follow up may be with colonoscopy or other screening modality for average risk individuals

SSP; sessile serrated polyp

Risk for metachronous advanced neoplasia among individuals with normal colonoscopy, 1 to 2 adenomas < 10mm in size, or high risk adenoma (adenoma >10 mm in size, adenoma with tubulovillous/villous histology, adenoma with high grade dysplasia or ≥3 adenomas < 10 mm) based on a meta-analysis of 10,139 across 8 surveillance studies is depicted²³. Risk for metachronous adenoma among individuals with no adenoma or 1 to 2 small adenomas is similar, and much lower than risk among individuals with baseline high risk adenoma. In studies that defined high risk as advanced adenoma alone (n=4 studies), cumulative advanced adenoma risk was 16% (95% CI: 9–25%), and in studies that defined high risk as advanced adenoma or >=3 adenomas <10 mm (n=4 studies), cumulative advanced adenoma risk was 19% (95% CI: 10–30%; Personal Communication, 9/18/18 Dube).