Colonoscopy should be repeated in 3 years. Patients with adenomas are at increased risk for colon cancer. They can be stratified into low- and high-risk groups for metachronous neoplasia based on the polyp size, number, and pathology. This risk stratification has a strong evidence base and guides when the next colonoscopy should be performed. Patients with (1) an adenoma 10 mm or larger, (2) three to ten adenomas, (3) an adenoma with a villous component (such as a tubulovillous or villous adenoma), or (4) an adenoma with high-grade dysplasia are considered high risk and should undergo their next colonoscopy in 3 years. Diminutive (<5 mm) rectosigmoid (hyperplastic) polyps are not a known risk factor for colorectal cancer and do not warrant more than average-risk colorectal cancer screening.

Patients with polyps larger than 20 mm or polyps removed in pieces should undergo their next colonoscopy in 3 to 6 months to ensure that no residual polyp tissue remains.

Patients with colon cancer, not adenomas, should have their first postoperative colonoscopy examination within 1 year of the clearing colonoscopy.

Patients with one to two tubular adenomas smaller than 10 mm are considered low risk and should undergo their next colonoscopy in 5 years.