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Follow-up recommendations after sessile serrated lesions (SSLs) vary across US and European guidelines. We analysed our cohort of patients with SSLs diagnosed between 2010 and 2019 in an index colonoscopy. Of 1156 patients, 455 with at least one SSL had regular follow-up and 471 not; of the latter, 212 could be followed after attempts to reach them. Overall, there were 64 (14.1%, 95% CI 11.0% to 17.6%) and 23 (10.8%, 95% CI 7.0% to 15.8%) cases of advanced SSL in the regular and the invited follow-up group, and 47 (10.3%, 95% CI 7.7% to 13.5%); 25 (11.8%, 95% CI 7.8% to 16.9%) advanced adenomas (AAs), respectively. Three cancers were detected (one in the regular and two in the invited follow-up group). Rates of AAs increased with longer follow-up: 8.8% for < 3 years; 9.9% for 3–4.9 years; 12.5% for 5–6.9 years and 21.2% for ≥7 years. Patients with >10 years follow-up had the highest rates of AAs (30.0%) and advanced SLs (ASLs) (20.0%).