ESGE Expands the Postpolypectomy Cohort With No Recommended Surveillance

ESGE Expands the Postpolypectomy Cohort With No Recommended Surveillance

Douglas K. Rex, MD, MASGE, reviewing Hassan C, et al. Endoscopy 2020 Jun 22.

The European Society of Gastrointestinal Endoscopy (ESGE) has issued its first update of postpolypectomy surveillance recommendations since 2013. Key recommendations include the following:

  • Patients with complete removal of 1 to 4 ≤10-mm adenomas with low-grade dysplasia, with or without villous components, or any serrated polyp <10 mm without dysplasia require no surveillance and should be returned to screening. In the absence of organized screening, this means repeat colonoscopy in 10 years.
  • Patients with any of the following should have surveillance colonoscopy at 3 years: at least 1 adenoma ≥10 mm, any adenoma with high-grade dysplasia, 5 or more adenomas, a serrated polyp ≥10 mm, or any serrated polyp with dysplasia.
  • If a surveillance colonoscopy at 3 years detects no findings requiring further surveillance, another colonoscopy should be performed at 5 years. 
  • At the 5-year colonoscopy, if there are no findings requiring surveillance, the patient should be returned to screening. 
  • A repeat colonoscopy should be performed 3 to 6 months after piecemeal resection of a polyp ≥20 mm. A second surveillance is recommended 12 months later. 
  • Surveillance intervals should not be altered for a family history of colorectal cancer.
  • Colonoscopists should consider stopping surveillance in patients who are age ≥80 years or earlier if life expectancy is lower because of comorbidities.

Douglas K. Rex, MD, FASGE


These recommendations are similar to those released recently by the British Society of Gastroenterology. Guidelines from the U.S. Multi-Society Task Force on Colorectal Cancer remain more conservative, and the task force has not expanded the “no-surveillance-recommended” cohort to the extent seen in these guidelines.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Hassan C, Antonelli G, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline – update 2020. Endoscopy 2020 Jun 22. (Epub ahead of print) (

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