Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discoveredduring colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important meth-od for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance isrequired because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic ap-proach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. Thekey recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size;(2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adeno-ma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance intervalto prevent metachronous CRC.