Table 1.

US-based and International Guidance for Colonoscopic Surveillance in Inflammatory Bowel Disease

Guidelines and Methodology	Screening initiation (yrs after symptom onset)*	Surveillance intervals	Risk Categories
US-Based Guidelines (ACG, ASGE) and Clinical Practice Update (AGA)
ACG 2019 GRADE	8–10 yrs	1–2 yrs	Annual surveillance in PSC, otherwise every 1–3 years based on the number of risk factors for CRC and findings from the previous colonoscopy, albeit with no discrete risk categorization groups
ASGE 2015 GRADE	8 yrs	1–3 yrs	Annual surveillance in PSC, ”active” inflammation*, anatomic abnormality (stricture, multiple pseudopolyps), history of dysplasia, CRC in FDR. Acknowledge optimal surveillance interval is otherwise not defined.
AGA 2021 (Clinical Practice Update)	8–10 yrs	1–5 yrs	Annual surveillance: PSC, moderate or severe inflammation (any extent), CRC in FDR<50, dense pseudopolyposis, history of invisible dysplasia or higher-risk visible dysplasia within the past 5 years Every 2–3 years: mild inflammation (any extent), strong family history of CRC (but not FDR<50), features of prior severe colitis (moderate pseudopolyps, extensive mucosal scarring), history of invisible dysplasia or higher-risk visible dysplasia >5 years ago, history of lower-risk visible dysplasia<5 years ago Every 5 years: continuous disease remission since last colonoscopy with mucosal healing on current exam, plus either: >/= 2 consecutive exams without dysplasia or minimal historical colitis extent
European-Based Guidelines
ECCO 2017 (UC only) Expert consensus agreement	8 yrs	High: 1 yr Intermediate: 2–3 yrs Not intermediate or high: 5 yrs	High-risk: extensive colitis with severe active inflammation; stricture or dysplasia detected within the past 5 years; PSC; or CRC in FDR <50 years Intermediate-risk: extensive colitis with mild-moderate active inflammation, pseudopolyps or CRC in FDR >50yrs
BSG 2019 GRADE	8 yrs	High: 1 yr Intermediate: 3 yrs Low: 5 yrs	High-risk: Same as ECCO except moderate-severe active endoscopic/histologic inflammation Intermediate-risk: Same as ECCO except mild active endoscopic/histologic inflammation Low-risk: extensive colitis with no active endoscopic/histologic inflammation, OR left-sided colitis, OR Crohn’s colitis <50% colon
NICE 2011 NICE guideline protocol	10 yrs	High: 1 yr Intermediate: 3 yrs Low: 5 yrs	High-, intermediate-, and low-risk: same as BSG
German 2019 (UC only) Expert consensus agreement	8 yrs	High: 1 yr Intermediate: 2–3 yrs Low: 4 yrs	High-risk: Same as ECCO Intermediate-risk: Same as ECCO Low-risk: No criteria for high- or intermediate-risk
Asian-Based Guidelines
AOCC and APAG, 2020 Expert consensus agreement; GRADE	8 yrs	No guidance provided regarding routine surveillance	Patients with UC and LGD in flat mucosa should have repeat exam in 3–6 months. Otherwise, no statements regarding follow up surveillance are provided
JSG, 2020 GRADE; consensus	8 yrs (UC only)	No guidance provided regarding routine surveillance	“A determination of the optimal surveillance interval incorporating both the CRC risk and progression speed is warranted”
Other Geography-Specific Guidelines
Australian NHMRC 2018 NHMRC protocol	8 yrs ^	High: 1 yr Intermediate: 3 yrs Low: 5 yrs	High-risk: Any of: PSC, ongoing chronic active inflammation*, prior dysplasia, stricture, pseudopolyps, tubular colon, CRC in FDR ≤50 Intermediate-risk: All of: quiescent disease, no high-risk features, CRC in FDR >50yrs Low-risk: All of: no other risk factors and quiescent disease on consecutive exams
CAG-CDHF 2004	No country specific consensus guidelines, but endorse both AGA and BSG guidelines

^*Most guidelines distinctly state that these surveillance initiation intervals apply to patients without PSC. In patients with PSC, screening should occur at the time of PSC diagnosis.

^{^}or 10 yrs prior to the age of the youngest relative with CRC, whichever is first.

Abbreviations: ACG, American College of Gastroenterologists; AGA, American Gastroenterological Association; AOCC, Asian Organization for Crohn’s and Colitis; APAG, Asia Pacific Association of Gastroenterology; ASGE, American Society of Gastrointestinal Endoscopy; BSG, British Society of Gastroenterology; CAG-CDHF, Canadian Association of Gastroenterology and Canadian Digestive Health Foundation; CRC, colorectal cancer; CRN, colorectal neoplasia; ECCO, European Crohn’s and Colitis Organization; FDR, first-degree relative; JSG, Japanese Society of Gastroenterology; NHMRC, National Health and Medical Research Council; NICE, National Institute for Health and Care Excellence; PSC, primary sclerosing cholangitis

Note: The AGA retired the AGA guidelines published in 2010 (Farraye et al.). As such, these are not presented in the table above. A recent expert review was approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board on the topic of endoscopic surveillance and management of colorectal dysplasia in IBD. This document provides best practice advice statements which underwent internal and external peer review.