Colonoscopy is an important diagnostic and therapeutic tool for the identification and removal of colorectal cancer precursors, such as adenomas and serrated polyps. It plays a crucial role in the prevention and monitoring of patients with an increased risk of colorectal cancer, including individuals with inflammatory bowel diseases, familial polyposis syndromes, and those with a history of pelvic or abdominal radiation therapy. This article discusses endoscopic surveillance in patients with inflammatory bowel diseases (ulcerative colitis, Crohn’s disease), after endoscopic polypectomy of adenomas and serrated polyps, and after resection of colorectal cancer. The guidelines consider risk factors, time intervals, and indications for subsequent colorectal examinations. For inflammatory bowel diseases, screening is recommended at 8 years after the onset of symptoms, with an individualised approach based on the risk group. The management of dysplastic lesions involves different surveillance intervals, depending on the type and extent of the resection performed, and the characteristics of the removed lesion. Patients after radical resection of colorectal cancer should have their first colonoscopy performed after one year, followed by subsequent examinations at 3 and 5 years post-operatively. Optimising endoscopic surveillance is a key element in ensuring the effectiveness, accessibility, and quality of performed procedures. The quality of colonoscopy depends directly on proper bowel preparation for the examination and the analysis of retrieved specimens. A balance between the frequency and quality of colonoscopy is crucial for effective oncological surveillance while minimising the negative effects of excessive endoscopic procedures.