Colonoscopy after polyps: when is the next one due?
After polyps are removed, the next colonoscopy can be due in as little as 6 months or as long as 10 years, depending on what kind of polyps they were, how big and how many. The intervals below come from the US Multi-Society Task Force on Colorectal Cancer, a group of US gastroenterology societies. Your doctor decides your date from your reports. (USMSTF, 2020)
When to repeat it, by what was found
These intervals assume a high-quality exam: the whole colon was seen, the bowel prep was good enough, and the polyps were completely removed. (USMSTF, 2020)
| What the colonoscopy found | Next colonoscopy |
|---|---|
| Normal colonoscopy (no polyps of the kinds below) | 10 years (USMSTF, 2020) |
| 1 to 2 tubular adenomas smaller than 10 mm | 7 to 10 years (USMSTF, 2020) |
| 3 to 4 tubular adenomas smaller than 10 mm | 3 to 5 years (USMSTF, 2020) |
| 5 to 10 tubular adenomas smaller than 10 mm | 3 years (USMSTF, 2020) |
| An adenoma 10 mm or larger, or with villous features or high-grade dysplasia | 3 years (USMSTF, 2020) |
| More than 10 adenomas | 1 year (USMSTF, 2020) |
| A polyp 20 mm or larger removed in pieces (piecemeal) | About 6 months, then 1 year later, then 3 years after that (USMSTF, 2020) |
| Hyperplastic polyps smaller than 10 mm | 10 years (USMSTF, 2020) |
| Hyperplastic polyp 10 mm or larger | 3 to 5 years (USMSTF, 2020) |
| 1 to 2 sessile serrated polyps smaller than 10 mm | 5 to 10 years (USMSTF, 2020) |
| 3 to 4 sessile serrated polyps smaller than 10 mm | 3 to 5 years (USMSTF, 2020) |
| 5 to 10 sessile serrated polyps smaller than 10 mm | 3 years (USMSTF, 2020) |
| A sessile serrated polyp 10 mm or larger, or with dysplasia; or a traditional serrated adenoma | 3 years (USMSTF, 2020) |
For a normal colonoscopy or small hyperplastic polyps in the rectum or sigmoid colon, the Task Force says to repeat screening in 10 years, which can be any recommended screening test; for the other rows it says a repeat colonoscopy. (USMSTF, 2020)
The words on your report, in plain terms
- Adenoma (tubular, villous): the polyp type most of the table is about; size, number, and villous features or high-grade dysplasia set the interval. (USMSTF, 2020)
- Hyperplastic polyp: small ones get the same 10-year interval as a normal exam. (USMSTF, 2020)
- Sessile serrated polyp and traditional serrated adenoma: serrated polyps, with their own follow-up rules in the table. (USMSTF, 2020)
- High-grade dysplasia: a finding on the pathology report that moves the next exam to 3 years. (USMSTF, 2020)
Your doctor reads your colonoscopy and pathology reports together.
Why this is surveillance, not screening
The USPSTF recommends colorectal cancer screening from 45 to 75 for adults at average risk, meaning no past colorectal cancer, adenomatous polyps or inflammatory bowel disease. Once adenomas have been found, the follow-up colonoscopies are called surveillance, and the USPSTF advice no longer sets the interval. (USPSTF, 2021) More: colorectal cancer screening.
After a positive stool test
If a FIT, stool DNA or other stool test comes back positive, the next step is a colonoscopy; the USPSTF says screening only works if that follow-up happens. (USPSTF, 2021) What that colonoscopy finds then sets your next date, using the table above. Medicare Part B covers that follow-up colonoscopy as a screening test, with nothing to pay for the screening if your provider accepts assignment. (Medicare.gov) More: after an abnormal screening result.
After 75
The Task Force says more research is needed on whether surveillance after 75, or with several other health conditions, does more good than the risks of the procedure. (USMSTF, 2020) For screening, the USPSTF says clinicians should selectively offer it from 76 to 85, deciding case by case. (USPSTF, 2021) Your doctor weighs your health and past results. More: when to stop screening.
What Medicare pays for
Part B covers a screening colonoscopy once every 24 months if you are at high risk for colorectal cancer, and otherwise once every 120 months, or 48 months after a flexible sigmoidoscopy. You pay nothing for the screening if your provider accepts assignment. If a polyp or other tissue is removed, you pay 15% of the Medicare-approved amount for your provider's services, and a 15% coinsurance to the facility in a hospital outpatient setting or ambulatory surgical center; the Part B deductible does not apply. (Medicare.gov) Ask your doctor what you will owe.
Questions people ask
How soon do I need another colonoscopy after polyps were removed?
It depends on the kind, size and number of polyps. Under the 2020 US Multi-Society Task Force update, 1 to 2 small tubular adenomas mean a repeat in 7 to 10 years, while larger or more numerous polyps mean 3 years or sooner. Your doctor sets your date from your colonoscopy and pathology reports. (USMSTF, 2020)
I was told 5 years after 1 or 2 small polyps. Is that wrong?
Not necessarily. The 2012 Task Force advice gave a shorter interval, and the 2020 update says people given an earlier date can reasonably follow it, while doctors may re-evaluate and give an updated one. Ask your doctor. (USMSTF, 2020)
Is a colonoscopy after polyps still screening?
Not in the USPSTF sense. The USPSTF screening advice is for people at average risk, which it defines as no past adenomatous polyps, colorectal cancer or inflammatory bowel disease. Follow-up after polyps is called surveillance, and its timing comes from your doctor and groups such as the Task Force. (USPSTF, 2021) (USMSTF, 2020)
Does Medicare pay for a colonoscopy after polyps?
Medicare Part B covers a screening colonoscopy once every 24 months if you are at high risk for colorectal cancer, or once every 120 months if you are not. If a polyp is removed, you pay 15% of the approved amount for the provider, plus a 15% facility coinsurance in a hospital outpatient setting or surgery center. Ask your doctor and Medicare which applies to you. (Medicare.gov)