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Polyp surveillance should be based on estimated polyp size at index colonoscopy, therefore accurate estimation of polyp size is crucial to manage large polyps effectively, but also to avoid over investigation of smaller polyps.We looked at a random sample of 99 polyps sent to the pathology laboratory and compared the endoscopist's estimate of polyp size with the pathologist's measurement.Of the 99 samples sent from endoscopy, 73 had their size recorded, range 1-40 mm (7.6 mm mean - 7.6 mm SD). The histopathologist reported size in 56 of 99 polyps ranging from 2- 30 mm (10.3 mm mean - 5.7 mm SD). 41/99 were sized both at endoscopy and pathology, and 9/99 sized by neither. Of the 41 polyps measured accurately by the histopathologist, 20 were underestimated by endoscopy (average of 2.95 mm) and 13 were overestimated (average of 4.8 mm). Using the BSG guidelines on surveillance following adenoma removal, five of the 41 patients (12.1%) were allocated to an incorrect follow-up group; 3/41 overestimated, leading to more aggressive and unnecessary follow-up. Two were underestimated, leading to under-investigation.Introduction of a simple measuring device in the endoscopy room may increase the accuracy of polyp estimation.