Colonoscopy Surveillance After Adenoma Removal: Current Guidelines

Colorectal cancer (CRC) is a major health issue and ranks among the top three of most common and deadliest cancers worldwide. Most CRCs develop from precancerous lesions that are identifiable at colonoscopy. Endoscopic detection and subsequent resection of those lesions results in a decrease in CRC incidence, morbidity, and mortality. To reduce the global burden of CRC, population-wide CRC screening programs have been introduced in many countries. With the implementation of these programs, the detection of lesions increased dramatically, leading to an increase in the number of individuals that are recommended to undergo colonoscopy surveillance after polypectomy. The aim of colonoscopy surveillance after polypectomy is to prevent cancers by timely detection and resection of premalignant lesions. However, the success of colonoscopy surveillance depends heavily on the quality of the procedure. The recommended intervals for colonoscopy surveillance are generally individualized, thus based on the estimated risk for an individual to develop new lesions or CRC. Most surveillance recommendations stratify individuals into different risk groups based on the observed lesion related risk factors: multiplicity, size, histopathologic (sub)type, and location. We aim to give a comprehensive overview of the current guidelines on colonoscopy surveillance after polypectomy and ongoing initiatives to improve these guidelines.