Postpolypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. In this report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy and we elucidated the high risk findings of the index colonoscopy as follows: 3 or more adenomas, any adenoma larger than 10 mm, any tubulovillous or villous adenoma, any adenoma with high-grade dysplasia, and any serrated polyps larger than 10 mm. Surveillance colonoscopy should be performed five years after the index colonoscopy for those without any high-risk findings and three years after the index colonoscopy for those with one or more high risk findings. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polypectomy, the patient's general condition, and family and medical history.

Citations

Citations to this article as recorded by  

• Post-colonoscopy colorectal cancers in a national fecal immunochemical test-based colorectal cancer screening program
  Pieter H. A. Wisse, Sybrand Y. de Boer, Marco Oudkerk Pool, Jochim S Terhaar sive Droste, Claudia Verveer, Gerrit A. Meijer, Evelien Dekker, Manon C. W. Spaander
  Endoscopy.2024; 56(05): 364.     CrossRef
• Recurrence rates of advanced colorectal neoplasia (ACN) in subjects with baseline ACN followed up at different surveillance intervals
  Martin C.S. Wong, Eman Yee-man Leung, Sam C.C. Chun, Yunyang Deng, Thomas Lam, Raymond S.Y. Tang, Junjie Huang
  Digestive and Liver Disease.2023; 55(12): 1742.     CrossRef
• Risk of recurrent advanced colorectal neoplasia in individuals with baseline non‐advanced neoplasia followed up at 5 vs 7–10 years
  Martin C. S. Wong, Eman Yee‐man Leung, Sam C. C. Chun, Yunyang Deng, Thomas Lam, Raymond S. Y. Tang, Junjie Huang
  Journal of Gastroenterology and Hepatology.2023; 38(12): 2122.     CrossRef
• Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance
  Joseph J Y Sung, Han-Mo Chiu, David Lieberman, Ernst J Kuipers, Matthew D Rutter, Finlay Macrae, Khay-Guan Yeoh, Tiing Leong Ang, Vui Heng Chong, Sneha John, Jingnan Li, Kaichun Wu, Simon S M Ng, Govind K Makharia, Murdani Abdullah, Nozomu Kobayashi, Masa
  Gut.2022; 71(11): 2152.     CrossRef
• Optimization of the surveillance strategy in patients with colorectal adenomas: A combination of clinical parameters and index colonoscopy findings
  Chan Hyuk Park, Yoon Suk Jung, Nam Hee Kim, Jung Ho Park, Dong Il Park, Chong Il Sohn
  Journal of Gastroenterology and Hepatology.2021; 36(4): 974.     CrossRef
• Increasing changes in visceral adiposity is associated with higher risk for colorectal adenoma: Multilevel analysis in a prospective cohort
  Jung Min Moon, Jong Pil Im, Donghee Kim, Yoo Min Han, Hosim Soh, Ji Hyun Song, Sun Young Yang, Young Sun Kim, Jeong Yoon Yim, Seon Hee Lim, Joo Sung Kim
  Journal of Gastroenterology and Hepatology.2021; 36(7): 1836.     CrossRef
• Strategies for colorectal cancer screening and post-polypectomy surveillance for young adults under age 50
  Yoon Suk Jung
  Precision and Future Medicine.2021; 5(2): 69.     CrossRef
• Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey
  Chang Kyo Oh, Satimai Aniwan, Panida Piyachaturawat, Zhiqin Wong, Thida Soe, Bayasgalan Luvsandagva, Quang Trung Tran, Achmad Fauzi, Jeong-Sik Byeon, Young-Seok Cho
  Gut and Liver.2021; 15(6): 878.     CrossRef
• Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines
  Sang Hyun Park, Kwang Il Hong, Hyun Chul Park, Young Sun Kim, Gene Hyun Bok, Kyung Ho Kim, Dong Suk Shin, Jae Yong Han, Young Kwan Kim, Yeun Jong Choi, Soo Hoon Eun, Byung Hoon Lim, Kyeong Kun Kwack
  The Korean Journal of Gastroenterology.2021; 78(6): 328.     CrossRef
• Effect of Cotinine-Verified Change in Smoking Status on Risk of Metachronous Colorectal Neoplasia After Polypectomy
  Yoon Suk Jung, Nam Hee Kim, Mi Yeon Lee, Jung Ho Park, Dong Il Park, Chong Il Sohn
  Clinical Gastroenterology and Hepatology.2020; 18(1): 163.     CrossRef
• Risk of developing metachronous advanced colorectal neoplasia after resection of low-risk diminutive versus small adenomas
  Nam Hee Kim, Yoon Suk Jung, Jung Ho Park, Dong Il Park, Chong Il Sohn
  Gastrointestinal Endoscopy.2020; 91(3): 622.     CrossRef
• Colorectal sessile serrated lesion with large size or synchronous neoplasm: a prospective study
  Laxmi B. Chavali, Kun Hu, Anish Sheth, Nan Gao, Wei Xiong, Lanjing Zhang
  European Journal of Gastroenterology & Hepatology.2020; 32(2): 199.     CrossRef
• Colorectal Polyp Prevalence According to Alcohol Consumption, Smoking and Obesity
  Kyujin Lee, Yong Hwan Kim
  International Journal of Environmental Research and Public Health.2020; 17(7): 2387.     CrossRef
• Comparative systematic review and meta-analysis of 1- to 5-mm versus 6- to 9-mm adenomas on the risk of metachronous advanced colorectal neoplasia
  Yoon Suk Jung, Tae Jun Kim, Eunwoo Nam, Chan Hyuk Park
  Gastrointestinal Endoscopy.2020; 92(3): 692.     CrossRef
• The current capacity and quality of colonoscopy in Korea
  Jae Ho Choi, Jae Myung Cha, Jin Young Yoon, Min Seob Kwak, Jung Won Jeon, Hyun Phil Shin
  Intestinal Research.2019; 17(1): 119.     CrossRef
• Appropriate Surveillance Interval after Colonoscopic Polypectomy in Patients Younger than 50 Years
  Yoon Suk Jung, Nam Hee Kim, Jung Ho Park, Dong Il Park, Chong Il Sohn
  Journal of Korean Medical Science.2019;[Epub]     CrossRef
• Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia
  Seth D. Crockett, Iris D. Nagtegaal
  Gastroenterology.2019; 157(4): 949.     CrossRef
• Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas
  Nam Hee Kim, Yoon Suk Jung, Mi Yeon Lee, Jung Ho Park, Dong Il Park, Chong Il Sohn
  American Journal of Gastroenterology.2019; 114(10): 1657.     CrossRef
• Visceral obesity as a risk factor for colorectal adenoma occurrence in surveillance colonoscopy
  Jong Pil Im, Donghee Kim, Su Jin Chung, Eun Hyo Jin, Yoo Min Han, Min Jung Park, Ji Hyun Song, Sun Young Yang, Young Sun Kim, Jeong Yoon Yim, Seon Hee Lim, Joo Sung Kim
  Gastrointestinal Endoscopy.2018; 88(1): 119.     CrossRef
• Guideline Adherence to Colonoscopic Surveillance Intervals after Polypectomy in Korea: Results from a Nationwide Survey
  Seri Hong, Mina Suh, Kui Son Choi, Boyoung Park, Jae Myung Cha, Hyun-Soo Kim, Jae Kwan Jun, Dong Soo Han
  Gut and Liver.2018; 12(4): 426.     CrossRef
• Risk factors of nonadherence to colonoscopy surveillance after polypectomy and its impact on clinical outcomes: a KASID multicenter study
  Chung Hyun Tae, Chang Mo Moon, Seong-Eun Kim, Sung-Ae Jung, Chang Soo Eun, Jae Jun Park, Geom Seog Seo, Jae Myung Cha, Sung Chul Park, Jaeyoung Chun, Hyun Jung Lee, Yunho Jung, Jin Oh Kim, Young-Eun Joo, Dong Il Park
  Journal of Gastroenterology.2017; 52(7): 809.     CrossRef
• Unusual Local Recurrence with Distant Metastasis after Successful Endoscopic Submucosal Dissection for Colorectal Mucosal Cancer
  Hyo Jeong Lee, Byong Duk Ye, Jeong-Sik Byeon, Jihun Kim, Young Soo Park, Yong Sang Hong, Yong Sik Yoon, Dong-Hoon Yang
  Clinical Endoscopy.2017; 50(1): 91.     CrossRef
• Determining the optimal surveillance interval after a colonoscopic polypectomy for the Korean population?
  Jung Lok Lee, Jae Myung Cha, Hye Min Lee, Jung Won Jeon, Min Seob Kwak, Jin Young Yoon, Hyun Phil Shin, Kwang Ro Joo, Joung Il Lee, Dong Il Park
  Intestinal Research.2017; 15(1): 109.     CrossRef
• Advanced Colonic Neoplasia at Follow-up Colonoscopy According to Risk Components and Adenoma Location at Index Colonoscopy: A Retrospective Study of 1,974 Asymptomatic Koreans
  Su Jung Baik, Hyojin Park, Jae Jun Park, Hyun Ju Lee, So Young Jo, Yoo Mi Park, Hye Sun Lee
  Gut and Liver.2017; 11(5): 667.     CrossRef
• The Serrated Polyp Pathway: Is It Time to Alter Surveillance Guidelines?
  Brendon O’Connell, Nazar Hafiz, Seth Crockett
  Current Gastroenterology Reports.2017;[Epub]     CrossRef
• Optimizing post‐polypectomy surveillance: A practical guide for the endoscopist
  Roel Bogie, Silvia Sanduleanu
  Digestive Endoscopy.2016; 28(3): 348.     CrossRef
• Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos)
  Dong-Hoon Yang, Yangsoon Park, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
  Gastrointestinal Endoscopy.2016; 83(5): 1015.     CrossRef
• Colorectal cancer screening of the general population in East Asia
  Yasushi Sano, Jeong‐Sik Byeon, Xiao‐Bo Li, Martin C.S. Wong, Han‐Mo Chiu, Rungsun Rerknimitr, Takahiro Utsumi, Santa Hattori, Wataru Sano, Mineo Iwatate, Philip Chiu, Joseph Sung
  Digestive Endoscopy.2016; 28(3): 243.     CrossRef
• Surveillance colonoscopy after endoscopic treatment for colorectal neoplasia: From the standpoint of the Asia–Pacific region
  Takahisa Matsuda, Han‐Mo Chiu, Yasushi Sano, Takahiro Fujii, Akiko Ono, Yutaka Saito
  Digestive Endoscopy.2016; 28(3): 342.     CrossRef
• Long-Term Outcome and Surveillance Colonoscopy after Successful Endoscopic Treatment of Large Sessile Colorectal Polyps
  Bun Kim, A Ra Choi, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Sung Pil Hong
  Yonsei Medical Journal.2016; 57(5): 1106.     CrossRef
• Probability of High-Risk Colorectal Neoplasm Recurrence Based on the Results of Two Previous Colonoscopies
  Hye Won Park, Seungbong Han, Ji Young Lee, Hye-Sook Chang, Jaewon Choe, Yunsik Choi, Hoonsub So, Dong-Hoon Yang, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Jeong-Sik Byeon
  Digestive Diseases and Sciences.2015; 60(1): 226.     CrossRef
• Distribution of the Colonoscopic Adenoma Detection Rate According to Age: Is Recommending Colonoscopy Screening for Koreans Over the Age of 50 Safe?
  Taeseok Bae, Yunhyung Ha, Changkyun Kim, Jihyun Lee, Kwangil Ha, Sanghyun Shin, Youngcheol Lee, Yoonsik Kang
  Annals of Coloproctology.2015; 31(2): 46.     CrossRef
• Risk of adenomas with high‐risk characteristics based on two previous colonoscopy
  Kang‐Heum Suh, Ja Seol Koo, Jong Jin Hyun, Jungsoon Choi, Jang Soo Han, Seung Young Kim, Sung Woo Jung, Yoon Tae Jeen, Sang Woo Lee, Jai Hyun Choi
  Journal of Gastroenterology and Hepatology.2014; 29(12): 1985.     CrossRef
• Only the Size of Resected Polyps Is an Independent Risk Factor for Delayed Postpolypectomy Hemorrhage: A 10-Year Single-Center Case-Control Study
  Hee Seok Moon, Sun Wook Park, Dong Hwan Kim, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong
  Annals of Coloproctology.2014; 30(4): 182.     CrossRef
• Prevalence of and Risk Factors for Gastrointestinal Diseases in Korean Americans and Native Koreans Undergoing Screening Endoscopy
  Hee Sun Kim, Su Jung Baik, Kyung Hee Kim, Cho Rong Oh, Jung Hyun Lee, Wan Jae Jo, Hye Kyoung Kim, Eun Young Kim, Min Jung Kim
  Gut and Liver.2013; 7(5): 539.     CrossRef
• Proximal colon cancer and serrated adenomas – hunting the missing 10%
  Pelvender Gill, Hannah Rafferty, David Munday, Adam Bailey, Lai Mun Wang, James E East, Runjan Chetty, Simon J Leedham
  Clinical Medicine.2013; 13(6): 557.     CrossRef
• Relationship of Non-Alcoholic Fatty Liver Disease to Colorectal Neoplasia
  Jue Yong Lee, Ja Won Kim
  Korean Journal of Medicine.2013; 84(3): 363.     CrossRef
• Highlights of International Digestive Endoscopy Network 2013
  Kwang An Kwon, Il Ju Choi, Eun Young Kim, Seok Ho Dong, Ki Baik Hahm
  Clinical Endoscopy.2013; 46(5): 425.     CrossRef

There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.

Citations

Citations to this article as recorded by  

• Modified underwater endoscopic mucosal resection for intermediate-sized sessile colorectal polyps
  Dong Hyun Kim, Seon-Young Park, Hye-Su You, Yong-Wook Jung, Young-Eun Joo, Dae-Seong Myung, Hyun-Soo Kim, Nah Ihm Kim, Seong-Jung Kim, Jae Kyun Ju
  Frontiers in Medicine.2023;[Epub]     CrossRef
• Endoscopic treatment of colorectal polyps and early colorectal cancer
  Yunho Jung
  Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
• Circumferential submucosal incision prior to endoscopic mucosal resection versus conventional endoscopic mucosal resection for colorectal lesions with endoscopic features of sessile serrated lesions
  Chang Kyo Oh, Bo-In Lee, Sung Hak Lee, Seung-Jun Kim, Han Hee Lee, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho, Jae Myung Park, Young-Seok Cho, In Seok Lee, Myung-Gyu Choi
  Surgical Endoscopy.2022; 36(3): 2087.     CrossRef
• Polypectomy for Diminutive and Small Colorectal Polyps
  Melissa Zarandi-Nowroozi, Roupen Djinbachian, Daniel von Renteln
  Gastrointestinal Endoscopy Clinics of North America.2022; 32(2): 241.     CrossRef
• Risk of post-polypectomy bleeding after endoscopic mucosal resection in patients receiving antiplatelet medication: comparison between the continue and hold groups
  Sang Hyun Park, Soo-Kyung Park, Hyo-Joon Yang, Yoon Suk Jung, Jung Ho Park, Chong Il Sohn, Dong Il Park
  Surgical Endoscopy.2022; 36(9): 6410.     CrossRef
• Hot snare polypectomy versus endoscopic mucosal resection for small colorectal polyps: a randomized controlled trial
  Seung-Jun Kim, Bo-In Lee, Eun Sun Jung, Joon Sung Kim, Sun-Young Jun, Woohyeon Kim, Hyoju Ham, Minah Kim, Sung Hak Lee, Han Hee Lee, Jae Myung Park, Myung-Gyu Choi
  Surgical Endoscopy.2021; 35(9): 5096.     CrossRef
• Gastrointestinal and Nongastrointestinal Complications of Esophagogastroduodenoscopy and Colonoscopy in the Real World: A Nationwide Standard Cohort Using the Common Data Model Database
  Ha Il Kim, Jin Young Yoon, Min Seob Kwak, Jae Myung Cha
  Gut and Liver.2021; 15(4): 569.     CrossRef
• Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
  Hyun Lim, Eun Jeong Gong, Byung-Hoon Min, Seung Joo Kang, Cheol Min Shin, Jeong-Sik Byeon, Miyoung Choi, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun
  The Korean Journal of Gastroenterology.2020; 76(6): 282.     CrossRef
• Endoscopic Submucosal Dissection for Colitis-Associated Dysplasia
  Dong-Hoon Yang, Imelda Rey
  Clinical Endoscopy.2019; 52(2): 120.     CrossRef
• Prospective analysis of delayed colorectal post-polypectomy bleeding
  Soo-Kyung Park, Jeong Yeon Seo, Min-Gu Lee, Hyo-Joon Yang, Yoon Suk Jung, Kyu Yong Choi, Hungdai Kim, Hyung Ook Kim, Kyung Uk Jung, Ho-Kyung Chun, Dong Il Park
  Surgical Endoscopy.2018; 32(7): 3282.     CrossRef
• Endoscopic Instruments and Electrosurgical Unit for Colonoscopic Polypectomy
  Hong Jun Park
  Clinical Endoscopy.2016; 49(4): 350.     CrossRef
• Effectiveness of adjuvant radiotherapy after local excision of rectal cancer with deep submucosal invasion: a single-hospital, case–control analysis
  Seohyun Lee, Chang Gok Woo, Hyo Jeong Lee, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Young Soo Park, Jin-hong Park, Jong Hoon Kim, Seok-Byung Lim, Jin Cheon Kim, Chang Sik Yu, Dong-Hoon Yang
  Surgical Endoscopy.2015; 29(11): 3231.     CrossRef
• The Feasibility of Performing Colorectal Endoscopic Submucosal Dissection Without Previous Experience in Performing Gastric Endoscopic Submucosal Dissection
  Dong-Hoon Yang, Gwi Hong Jeong, Yerim Song, Sang Hyoung Park, Soo-Kyung Park, Jong Wook Kim, Kee Wook Jung, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Young Soo Park, Jeong-Sik Byeon
  Digestive Diseases and Sciences.2015; 60(11): 3431.     CrossRef
• Association between the Position of Colorectal Polyps and Clinical Outcomes of Polypectomy: Focused on Procedure Time, Complication and Histopatholgic Result
  Jung Hyun Park, Jae Hyeok Choi, Hyeong Jung Na, Won Geon Kwak, Jong Sun Choi, Eo Jin Kim, Jae Hak Kim
  Intestinal Research.2013; 11(3): 191.     CrossRef
• Preparation and Patient Evaluation for Safe Gastrointestinal Endoscopy
  Seong Hee Kang, Jong Jin Hyun
  Clinical Endoscopy.2013; 46(3): 212.     CrossRef
• International Digestive Endoscopy Network to Strengthen Network for Lower Gastrointestinal Diseases Including Inflammatory Bowel Disease and Colorectal Cancer
  Kwang An Kwon
  Clinical Endoscopy.2012; 45(3): 251.     CrossRef