Surveillance Colonoscopy After Polypectomy—Current Evidence and Future Directions

Colorectal cancer (CRC) incidence continues to steadily rise in various parts of the world, and there remains an urgent need for effective interventions to tackle this. Effective and timely implementation of CRC screening interventions and adherence to post polypectomy surveillance recommendations remain paramount. Colonoscopy is the gold standard for timely diagnosis and removal of precursor lesions or polyps to CRC; however, patient uptake and cost effectiveness, especially in the era of noninvasive testing strategies, require closer evaluation. Furthermore, the risk of progression to CRC varies with the morphology, size, and histology of colorectal polyps. Several colonoscopy-based resection techniques have been reported in literature to effectively and safely remove these precursor lesions. In this review, we summarize the current guidelines (US and Europe) and evidence for the effectiveness of post-polypectomy surveillance, resection, and surveillance for sessile serrated lesions. We also appraise the current literature regarding non-colonoscopy options for post colonoscopy surveillance, as well as interventions to boost adherence to surveillance.