Cherri S, Salvi D, Pezzuto E, Tabbone E, Zaniboni A, Cesaro P. Endoscopic follow-up in colorectal cancer: Comparisons and critical issues across different guidelines. World J Gastroenterol 2026; 32(32): 120118 [DOI: 10.3748/wjg.120118]
Corresponding Author of This Article
Daniele Salvi, MD, Consultant, Gastroenterology and Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati, Brescia 25124, Lombardy, Italy. daniele.salvi@poliambulanza.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Cherri S, Salvi D, Pezzuto E, Tabbone E, Zaniboni A, Cesaro P. Endoscopic follow-up in colorectal cancer: Comparisons and critical issues across different guidelines. World J Gastroenterol 2026; 32(32): 120118 [DOI: 10.3748/wjg.120118]
Author contributions: Cherri S and Salvi D made equal contributions as co-first authors; Cherri S, Salvi D, Tabbone E, and Pezzuto E contributed to drafting of the manuscript; Cherri S, Salvi D, and Pezzuto E contributed to tables and figures; Cesaro P and Zaniboni A contributed to critical revision of the manuscript for important intellectual content. All the authors read and approved the final manuscript.
AI contribution statement: The manuscript has undergone language polishing to adapt English! No other use of AI in this manuscript except for grammar checking and phrase rephrasing. No AI used to write the paper or to design the study. No images generated by AI.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Daniele Salvi, MD, Consultant, Gastroenterology and Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati, Brescia 25124, Lombardy, Italy. daniele.salvi@poliambulanza.it
Received: February 24, 2026 Revised: March 31, 2026 Accepted: May 14, 2026 Published online: August 28, 2026 Processing time: 169 Days and 20.7 Hours
Abstract
Endoscopic surveillance plays a fundamental role in the long-term management of patients treated for colorectal cancer. Despite significant advances in surgical techniques, systemic therapies, and molecular diagnostics, recurrence and metachronous neoplasia remain clinically relevant challenges, particularly within the first three years following curative-intent treatment. This review summarizes current evidence and major guideline recommendations on endoscopic follow-up after colorectal resection, endoscopic removal of early-stage tumors, and non-operative management strategies. We describe the natural history of precursor lesions and their variable malignant potential, emphasizing the importance of accurate characterization, complete resection, and risk-adapted surveillance. The growing adoption of organ-preserving approaches, such as the watch-and-wait strategy following total neoadjuvant therapy for rectal cancer, and immunotherapy-induced complete responses in microsatellite instability-high/deficient mismatch repair tumors, necessitates more intensive and prolonged monitoring, including structured endoscopic follow-up. As these oncologic surveillance strategies become increasingly widespread, clearly defined clinical pathways and standardized protocols will be essential. We highlight how risk-stratified endoscopic follow-up is critical for the early detection of recurrence, prevention of new primary tumors, and the safe implementation of non-surgical management pathways. The aim is to define a clear algorithm supporting follow-up across distinct clinical contexts: Post-surgical, post-endoscopic resection, and in patients who are candidates for non-operative management. Future research will need to integrate molecular biomarkers, refine risk stratification models, and harmonize surveillance algorithms to ensure effective and personalized follow-up for patients with colorectal cancer.
Core Tip: Endoscopy plays a central role in the long-term follow-up of patients treated for colorectal cancer, enabling early detection of recurrence and prevention of new primary tumors. Surveillance strategies should be risk-adapted, accounting for the natural history of precursor lesions, resection quality, and the distinct clinical settings of surgery, endoscopic resection, and non-operative management. The growing adoption of organ-preserving approaches, such as watch-and-wait after total neoadjuvant therapy and immunotherapy-induced complete responses in microsatellite instability-high/deficient mismatch repair tumors, requires more intensive and prolonged endoscopic monitoring. The goal is to develop clear, standardized algorithms that integrate clinical factors and emerging molecular biomarkers to ensure effective, personalized, and safe follow-up for patients with colorectal cancer.
