Colorectal cancer (CRC) incidence can be reduced through detection and removal of advanced polyps. Appropriate surveillance intervals after index colonoscopy are essential to balance cancer prevention with resource optimization. Delayed surveillance may increase the risk of advanced lesions or CRC incidence, whereas premature or unnecessary procedures expose patients to avoidable risks and burden endoscopy units.The aim of this study was to evaluate the adequacy of post-polypectomy surveillance indications according to European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Secondary objectives included identifying factors associated with inadequacy and assessing physicians’ knowledge of surveillance intervals

A retrospective, single-center, observational study was conducted. All colonoscopies performed between January 1st and June 30th, 2024, were reviewed. Only procedures indicated for post-polypectomy surveillance were included. To assess knowledge, a questionnaire with four clinical scenarios was sent to referring physicians.

Of 3,096 colonoscopies performed, 481 (15.5%) were post-polypectomy surveillance procedures. Among these, 270 (56.1%) had an inappropriate indication. Most of them (28.3%) corresponding to patients who did not require colonoscopy.The rate of advanced polyps was higher in delayed surveillance colonoscopies compared with those not requiring follow-up (16.5% vs 5.1%, p = 0.024).Inappropriate indications were significantly associated with patients having four or fewer adenomas in the previous colonoscopy (40.4%, p < 0.001). Requests from primary care showed a higher inadequacy rate compared with those from the gastroenterology department (79% vs 39.9%, p < 0.001). Appropriate indications were more frequent when colonoscopies were performed within the CRC screening program (65% vs 35.5%, p < 0.001).In the knowledge survey, 28 responses were received. The accuracy rate was ≥50% for all scenarios. The lowest score corresponded to surveillance after an advanced adenoma with high-grade dysplasia and size >10 mm, while the remaining cases showed >75% correct answers.

Adherence to ESGE post-polypectomy surveillance guidelines was low in our setting, with over half of colonoscopies inappropriately indicated. Most unnecessary requests corresponded to patients without an indication for endoscopic follow-up.

Referral from primary care, fewer than four adenomas, and absence from population-based screening programs were factors associated with inappropriate indications.

The overall level of knowledge among referring physicians was acceptable but could be improved, particularly in cases involving advanced adenomas with high-grade dysplasia.