Surveillance after endoscopic resection for colorectal tumors: a comprehensive review.

Abstract

Background: The goal of surveillance after the endoscopic resection of colorectal tumors is to reduce colorectal cancer (CRC) incidence and mortality. Considering the effective use of the limited endoscopic capacity and the cost of surveillance, it is desirable to develop a surveillance program that is as minimal as possible. In Europe (European Society of Gastrointestinal Endoscopy (ESGE)) and the United States (US) (Multi-Society Task Force (MSTF)), after the results of the National Polyp Study (NPS) were established, guidelines were developed that stratified risk based on initial endoscopy, and surveillance programs for each risk group were proposed. More than 10 years later, the "colonoscopy screening and surveillance guidelines" were developed with the basic principle of "aiming for zero colorectal cancer deaths during surveillance, bowel preservation, and emphasis on patient quality of life" as the guideline principles in Japan.

Summary: Randomized controlled trials (RCTs) to evaluate the appropriate surveillance intervals after endoscopic resection of colorectal tumors: the NPS, the Nottingham Study, and the Japan Polyp Study (JPS) are summarized. The ESGE, USMSTF, and Japanese guidelines compared low-risk adenoma, high-risk adenoma, advanced neoplasia, piecemeal resection, and serrated lesions by category.

Key messages: Surveillance guidelines based on risk stratification were developed in Japan. Guidelines are meaningful only when they are effectively utilized in clinical practice. They must also be revised based on new evidence. It is hoped that new knowledge will be accumulated, especially in Japan, on topics that are currently lacking.