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Canadian Journal of Gastroenterology
Volume 27, Issue 4, Pages 224-228
Original Article

Colorectal Cancer Surveillance after Index Colonoscopy: Guidance from the Canadian Association of Gastroenterology

Desmond Leddin,1 Robert Enns,2 Robert Hilsden,3 Carlo A Fallone,4 Linda Rabeneck,5 Daniel C Sadowski,6 and Harminder Singh7

1Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
2Department of Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
3University of Calgary, Calgary, Alberta, Canada
4McGill University, Montreal, Quebec, Canada
5University of Toronto, Toronto, Ontario, Canada
6Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
7Departments of Internal Medicine and Community Health Services, University of Manitoba, Winnipeg, Manitoba, Canada

Received 29 January 2013; Accepted 18 February 2013

Copyright © 2013 Canadian Association of Gastroenterology. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (, which permits reuse, distribution, and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.


BACKGROUND: Differences between American (United States [US]) and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.

METHODS: The Canadian Association of Gastroenterology (CAG) convened a working group (CAG-WG) to review available guidelines and provide unified guidance to Canadian clinicians regarding appropriate follow-up for colorectal cancer (CRC) surveillance after index colonoscopy. A literature search was conducted for relevant data that postdated the published guidelines.

RESULTS: The CAG-WG chose the 2012 US Multi-Society Task Force (MSTF) on Colorectal Cancer to serve as the basis for the Canadian position, primarily because the US approach was the simplest and comprehensively addressed the issue of serrated polyps. Aspects of other guidelines were incorporated where relevant. The CAG-WG recommendations differed from the US MSTF guidelines in three main areas: patients with negative index colonoscopy should be followed-up at 10 years using any of the appropriate screening tests, including colonos-copy, for average-risk individuals; among patients with >10 adenomas, a one-year interval for subsequent colonoscopy is recommended; and for long-term follow-up, patients with low-risk adenomas on both the index and first follow-up procedures can undergo second follow-up colonos-copy at an interval of five to 10 years.

DISCUSSION: The CAG-WG adapted the US MSTF guidelines for colonoscopy surveillance to the Canadian health care environment with a few modifications. It is anticipated that the present article will provide unified guidance that will enhance physician acceptance and encourage appropriate utilization of recommended surveillance intervals.