Adherence to 2020 US Multi-Society Task Force Guidelines for Post-Polypectomy Surveillance: a Multicenter Real-Time Analysis

Purpose: The U.S. Multi-Society Task Force (USMSTF) updated its 2020 guidelines to recommend less frequent post-polypectomy surveillance, yet premature colonoscopies remain common. Since the guidelines were published 5 years ago, we hypothesized that adherence has improved over time. We also aim to identify factors associated with non-adherence. Methods: This was a multicenter retrospective cohort study of 452 patients. 1st surveillance colonoscopies performed between 2020 and 2025 were included. Findings from pathology reports for both index and first surveillance colonoscopies were recorded. We considered follow-up after identifying hyperplastic polyps (HPs), low-risk adenomas (LRAs), or high-risk adenomas (HRAs) (the most advanced lesion was considered to be the lesion for which surveillance was indicated). Procedures performed more than 6 months earlier or later than recommended were defined as early or late, respectively. Results: Early surveillance occurred in 58% (n = 262/452) of 1st surveillance colonoscopies, while late surveillance occurred in 13% (n = 59/452). Early surveillance was performed in 82% of patients with only hyperplastic polyps (OR 5.47, 95% CI 1.60-18.72), and 64% of patients with only LRAs (OR 1.54, 95% CI 1.02–2.34). In contrast, patients with HRAs had delayed surveillance (OR 0.096, 95% CI 0.055–0.167). Early rates by year (2020–2025) were 46% (20/44), 50% (30/60), 57% (35/61), 70% (37/53), 51% (34/67), and 60% (100/167), respectively. Conclusions: Five years after the release of the 2020 USMSTF guidelines, adherence to recommended colonoscopy follow-up surveillance guidelines remains suboptimal. These findings highlight persistent gaps in guideline implementation.