← Issue №12/ week of Sep 20, 2026/Colorectal

Colonoscopy Intervals and Colorectal Cancer Incidence after Adenoma Removal.

From GI Signals issue №12: what this paper found, what it changes, and where it sits against the current standard of care, reviewed by Simon Mathews, MD.

Colorectal rct · n=10,799 · Sep 17, 2026 · NEJM · IF 84.5

Colonoscopy Intervals and Colorectal Cancer Incidence after Adenoma Removal.

Practice-changingcolorectal cancercolorectal cancer screeningadenoma
Clinical takeawayConsider extending the first surveillance colonoscopy interval to 5 years (vs 3 years) for patients with high-risk adenomas (≥1 adenoma ≥10 mm, high-grade dysplasia, villous growth, or 3-10 adenomas), pending final 10-year results.
What it found5-year cumulative incidence of colorectal cancer was 0.77% with 5-year surveillance vs 0.82% with 3-year surveillance (difference -0.05 percentage points; noninferiority margin 0.7 percentage points).
ContextChallenges current guideline recommendations for 3-year surveillance in high-risk adenoma patients, suggesting noninferiority of a 5-year interval in this interim analysis.
Emergingsuggested applicable standard· US Multi-Society Task Force on Colorectal Cancer (Gupta S, et al.), "Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2020

After polyp removal, assign the next colonoscopy surveillance interval using USMSTF 2020 based on polyp number, size, and histology (e.g., 1-2 tubular adenomas <10 mm 7-10 years; 3-4 tubular adenomas <10 mm 3-5 years; 5-10 tubular adenomas <10 mm, any adenoma ≥10 mm, or adenoma with tubulovillous/villous histology or high-grade dysplasia 3 years; >10 adenomas 1 year with polyposis evaluation; and for serrated polyps, 1-2 sessile serrated lesions <10 mm 5-10 years, 3-4 sessile serrated lesions <10 mm or a hyperplastic polyp ≥10 mm 3-5 years, and a sessile serrated lesion ≥10 mm or with dysplasia or a traditional serrated adenoma 3 years), and apply the shortest interval indicated when findings are mixed.

From our summary of this standard, unedited — the part the paper bears on. marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

After polyp removal, assign the next colonoscopy surveillance interval using USMSTF 2020 based on polyp number, size, and histology (e.g., 1-2 tubular adenomas <10 mm 7-10 years; 3-4 tubular adenomas <10 mm 3-5 years; 5-10 tubular adenomas <10 mm, any adenoma ≥10 mm, or adenoma with tubulovillous/villous histology or high-grade dysplasia 3 years; >10 adenomas 1 year with polyposis evaluation; and for serrated polyps, 1-2 sessile serrated lesions <10 mm 5-10 years, 3-4 sessile serrated lesions <10 mm or a hyperplastic polyp ≥10 mm 3-5 years, and a sessile serrated lesion ≥10 mm or with dysplasia or a traditional serrated adenoma 3 years), and apply the shortest interval indicated when findings are mixed. Confirm complete resection and adequate prep before applying an interval, and use site-check/tumor-board pathways for piecemeal resection and malignant (T1) polyps. Refer for genetic evaluation when Lynch, FAP/AFAP/MAP, or serrated polyposis syndrome criteria are met.

US Multi-Society Task Force on Colorectal Cancer (Gupta S, et al.), "Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2020 · reviewed 2026-07-23 ↗
Jover R … EPoS Study Group · New England Journal of Medicine · IF 84.5 · PubMed ↗Permalink
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