Colonoscopy Guidelines | August 2022 | Clinical Corner

August 1, 2022




The U.S. Multi-Society Task Force on Colorectal Cancer updated recommended follow-up intervals after screening colonoscopy in average-risk individuals. This guidance does not apply to people with hereditary syndromes that increase Colorectal Cancer (CRC) risk, inflammatory bowel disease, serrated polyposis syndrome, or personal or family history of CRC. These guidelines consider colonoscopy results alone and do not evaluate the role of other screening tools. Each should be considered on a case-by-case basis.



Normal Colonoscopy

  • 10 year follow up

Tubular Adenomas

  • For one to two adenomas, a seven- to 10-year follow-up interval is recommended.
  • For three to four adenomas, a three- to five-year follow-up is recommended.
  • For five to 10 adenomas, a three-year follow-up is recommended.
  • When more than 10 adenomas are found, a hereditary polyposis syndrome is likely, and repeat colonoscopy is recommended in one year.
  • Adenomas that are at least 10 mm in diameter or that have pathology reported as tubulo-villous, villous, or high-grade dysplasia, repeat colonoscopy is recommended at three years.

  Traditional Serrated Adenomas

  • Confer a higher neoplasia risk than tubular adenomas, so a three-year follow-up colonoscopy is recommended.

  Sessile Serrated Polyps

  • When sessile serrated polyps are at least 10 mm in diameter or have dysplasia, a three-year follow-up is recommended.
  • Without these features:
    • One to two polyps, a five to 10-year follow-up is recommended.
    • Three to four polys, a three to 5-year follow-up is recommended.
    • Five to ten polyps, a 3-year follow-up is recommended.

     Hyperplastic Polyps

  • Hyperplastic polyps smaller than 10 mm do not increase risk and can be part of a normal colonoscopy.
  • A three- to five-year follow-up is recommended for a hyperplastic polyp 10 mm or larger.
  • Finding more than 20 hyperplastic polyps suggests a serrated polyposis syndrome, whereas fewer than 20 hyperplastic polyps smaller than 10 mm indicates a low risk for neoplasia.



Am Fam Physician. 2021;103(5):314-316