Background and study aims Detection and treatment of recurrence after piecemeal endoscopic mucosal resection of non-pedunculated colorectal polyps is crucial to avoid post-colonoscopy cancer. Linked Color Imaging (LCI) has demonstrated to improve polyp detection but has never been assessed for evaluation of post-polypectomy scars. Our aim was to compare sensitivity and negative predictive value between LCI and white-light endoscopy (WLE) for detection of post-polypectomy recurrence. Design Single center randomized cross-over study. Patients undergoing surveillance colonoscopy after resection of lesions ≥15mm were included. Each post-polypectomy scar had two explorations: one with LCI and the other with WLE performed by two blinded endoscopists. After this, Blue Light Imaging (BLI) was applied. A diagnosis of recurrence with a level of confidence was made with each light and histopathology was the gold standard. Results One hundred twenty-nine patients with 173 scars were included. Baseline patient, lesion and procedural characteristics were similar in both arms. Recurrence was detected in 56/173 (32%), 27/56 (48%) adenomas and 29/56 (52%) serrated lesions. LCI has greater sensitivity (95% CI) 96% (88-99) versus 89% (79-95) for WLE and negative predictive value 98% (93-99) LCI and 95% (89-98) for WLE. Paired concordance between modalities was 96%. In discordant cases, LCI identified 4 true positive cases not detected by WLE and reclassified one false-positive of WLE. WLE reclassified two false positives of LCI without any increase in recurrence detection. Conclusions. LCI is highly accurate and has better ability than WLE to rule out recurrence on post-polypectomy scars after resection of large polyps.