Colorectal cancer surveillance in Lynch syndrome: quality standards, emerging technology and complementary strategies

Lynch syndrome is the most common hereditary colorectal cancer syndrome, and colonoscopy remains the cornerstone of prevention. However, surveillance is limited by missed lesions, variable procedural quality, accelerated neoplastic progression, and the continued occurrence of post-colonoscopy colorectal cancers. This review examines gene-specific differences in colorectal cancer and adenoma risk, quality standards for surveillance colonoscopy, emerging artificial intelligence technologies, and complementary non-endoscopic strategies. Contemporary studies conducted in expert settings have reported higher adenoma detection rates, reflecting improvements in colonoscopy quality. At the same time, randomized trials have shown no clear additional benefit from computer-aided detection when added to high-quality colonoscopy. Among complementary strategies, fecal immunochemical testing may support prioritization and risk stratification, although its optimal threshold, testing interval, and safety for postponing colonoscopy remain uncertain. In parallel, blood-based biomarkers for cancer prediction remain exploratory. Future progress will depend on wider implementation of quality-assured surveillance and prospective validation of adjunctive tools that can safely guide colonoscopy timing and reduce the occurrence of post-colonoscopy colorectal cancers.