Hotta Kinichi, Matsuda Takahisa, Sano Yasushi, Fujii Takahiro, Saito Yutaka
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.
Digestion. 2025;106(2):131-137. doi: 10.1159/000542665. Epub 2024 Nov 21.
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 USA (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 CRC deaths during surveillance, bowel preservation, and emphasis on patient quality of life" as the guideline principles in Japan.
Randomized controlled trials 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.
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.
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 USA (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 CRC deaths during surveillance, bowel preservation, and emphasis on patient quality of life" as the guideline principles in Japan.
Randomized controlled trials 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.
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.
大肠肿瘤内镜切除术后监测的目标是降低结直肠癌（CRC）的发病率和死亡率。考虑到有效利用有限的内镜资源以及监测成本，制定尽可能精简的监测方案是很有必要的。在欧洲（欧洲胃肠内镜学会[ESGE]）和美国（多学会特别工作组[MSTF]），在国家息肉研究（NPS）结果确立后，制定了基于初次内镜检查进行风险分层的指南，并针对每个风险组提出了监测方案。十多年后，日本制定了“结肠镜筛查与监测指南”，其指导原则为“监测期间力求结直肠癌死亡零发生、保留肠道并重视患者生活质量”。
总结了评估大肠肿瘤内镜切除术后合适监测间隔的随机对照试验、NPS、诺丁汉研究和日本息肉研究（JPS）。ESGE、美国多学会特别工作组和日本的指南按类别比较了低风险腺瘤、高风险腺瘤、进展期肿瘤、分片切除和锯齿状病变。
日本制定了基于风险分层的监测指南。指南只有在临床实践中有效应用才有意义。它们还必须根据新证据进行修订。希望尤其是在日本，能在当前缺乏的主题上积累新知识。
大肠肿瘤内镜切除术后监测的目标是降低结直肠癌（CRC）的发病率和死亡率。考虑到有效利用有限的内镜资源以及监测成本，制定尽可能精简的监测方案是很有必要的。在欧洲（欧洲胃肠内镜学会[ESGE]）和美国（多学会特别工作组[MSTF]），在国家息肉研究（NPS）结果确立后，制定了基于初次内镜检查进行风险分层的指南，并针对每个风险组提出了监测方案。十多年后，日本制定了“结肠镜筛查与监测指南”，其指导原则为“监测期间力求结直肠癌死亡零发生、保留肠道并重视患者生活质量”。
总结了评估大肠肿瘤内镜切除术后合适监测间隔的随机对照试验、NPS、诺丁汉研究和日本息肉研究（JPS）。ESGE、美国多学会特别工作组和日本的指南按类别比较了低风险腺瘤、高风险腺瘤、进展期肿瘤、分片切除和锯齿状病变。
日本制定了基于风险分层的监测指南。指南只有在临床实践中有效应用才有意义。它们还必须根据新证据进行修订。希望尤其是在日本，能在当前缺乏的主题上积累新知识。
