Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO) Guideline

Authors: Cesare Hassan, Piotr Tomasz Wysocki, Lorenzo Fuccio, Thomas Seufferlein, Mário Dinis-Ribeiro, Catarina Brandão, Jaroslaw Regula, Leonardo Frazzoni, Maria Pellise, Sergio Alfieri, Evelien Dekker, Rodrigo Jover, Gerardo Rosati, Carlo Senore, Cristiano Spada, Ian Gralnek, Jean-Marc Dumonceau, Jeanin E. van Hooft, Eric van Cutsem, Thierry Ponchon

Main recommendations

1 We recommend post-surgery endoscopic surveillance for CRC patients after intent-to-cure surgery and appropriate oncological treatment for both local and distant disease. Strong recommendation, low quality evidence. 2 We recommend a high quality perioperative colonoscopy before surgery for CRC or within 6 months following surgery. Strong recommendation, low quality evidence. 3 We recommend performing surveillance colonoscopy 1 year after CRC surgery.We recommend post-surgery endoscopic surveillance for CRC patients after intent-to-cure surgery and appropriate oncological treatment for both local and distant disease.
Strong recommendation, low quality evidence.

2 We recommend a high quality perioperative colonoscopy before surgery for CRC or within 6 months following surgery.
Strong recommendation, low quality evidence.

3 We recommend performing surveillance colonoscopy 1 year after CRC surgery.
Strong recommendation, moderate quality evidence.

4 We do not recommend an intensive endoscopic surveillance strategy, e. g. annual colonoscopy, because of a lack of proven benefit.
Strong recommendation, moderate quality evidence.

5 After the first surveillance colonoscopy following CRC surgery, we suggest the second colonoscopy should be performed 3 years later, and the third 5 years after the second. If additional high risk neoplastic lesions are detected, subsequent surveillance examinations at shorter intervals may be considered.
Weak recommendation, low quality evidence.

6 After the initial surveillance colonoscopy, we suggest halting post-surgery endoscopic surveillance at the age of 80 years, or earlier if life-expectancy is thought to be limited by comorbidities.
Weak recommendation, low quality evidence.

7 In patients with a low risk pT1 CRC treated by endoscopy with an R0 resection, we suggest the same endoscopic surveillance schedule as for any CRC.
Weak recommendation, low quality evidence.