Purpose: Patients with longstanding, extensive UC or Crohn's colitis have an increased risk of colon cancer and require colonoscopic surveillance every 2 yrs. The purpose of this study is to determine the non-adherence rate to surveillance colonoscopies in our patient population and to determine the risk factors that are associated with non-adherence. Methods: 259 patients with UC or Crohn's colitis for at least 7 yrs and at least 1/3 of the colon involved participated in this cross-sectional questionnaire study. A chart review was also performed for each patient. Part of the questionnaire included a self-efficacy scale as it related to the ability to adhere to surveillance colonoscopy. Results: Median age was 48 and median disease duration 20 yrs. 44% of patients had UC, and 51% were female. 49% of patients had waited more than 2.5 yrs in between exams and 40% of patients had waited longer than 3 yrs in between exams. Self-reported adherence was higher than chart-documented adherence for all times in between exams. Patients who self-reported less than 6 months in between exams had a mean chart-documented adherence of 2.16 yrs in between exams. For self-reported frequencies of 1,2, and 3 yrs or more in between exams, the chart documented mean time intervals between exams were every 2.08, 3.16, and 4.32 yrs respectively. We validated our large self-efficacy (SE) scale and divided it into 4 subscales, all significant and valid: Social SE (ability to schedule, tell people, avoid embarrassment), Calm SE (ability to avoid anxiety associated with colonoscopies), Prepare SE (ability to take and to tolerate the preparation), and Doc Comm SE (ability to get doctor's attention and to ask questions). Both Calm and Social SE were associated positively with adherence, and Prepare and Doc Comm SE correlated positively with lower average time between screenings. Patients reporting that they have trouble with the preparation and scheduling, that they felt good and did not think the test was needed, and that they have had inadequate insurance coverage were less likely to adhere. By logistic regression, being Jewish, having high Social SE, and using alternative health care methods were positively related to adherence. Conclusion: At least 40–49% of patients do not adhere to surveillance colonoscopies. Many factors relate to adherence including demographic and clinical factors, doctor message, and self-efficacy.