自从2000年代初以来，结直肠癌（CRC）的死亡率急剧下降，这在很大程度上归因于筛查和去除癌前息肉。尽管取得了这些进展，CRC仍然是美国第二大癌症死因，预计2023年约有53,000人死亡。美国胃肠病学会（AGA）临床实践更新专家审查的目标是描述如何对个体进行CRC筛查和息肉切除后的监测，并强调填补现有文献中存在的差距的未来研究机会。该专家审查由AGA研究所临床实践更新委员会（CPUC）和AGA管理董事会委托和批准，以为AGA会员提供及时的指导，通过胃肠病学的标准程序，由CPUC进行内部同行评审和外部同行评审。这些最佳实践建议是基于对发表文献的综述和专家意见得出的。由于未进行系统综述，因此这些最佳实践建议不对证据质量或所提考虑的强度进行正式评级。最佳实践建议 第一条：所有有一级亲属（父母、兄弟姐妹或子女）被诊断为CRC的个体，尤其是在50岁之前，应视为对CRC的增加风险。 最佳实践建议 第二条：所有无CRC个人病史、炎症性肠病、遗传性CRC综合征、其他CRC易感情况或家族CRC病史的个体，应视为对CRC的平均风险。 最佳实践建议 第三条：对于对CRC的平均风险的个体，应在45岁开始筛查；而对于由于有一级亲属被诊断为CRC而对CRC的风险增加的个体，应在最年轻受影响亲属的诊断年龄之前10年或40岁（以早者为准）开始筛查。 最佳实践建议 第四条：对于开始进行CRC筛查的个体，应基于个体的年龄、已知或怀疑的遗传性CRC综合征、以及/或家族CRC病史进行风险分层。 最佳实践建议 第五条：年龄大于75岁的个体是否继续进行CRC筛查的决定应根据风险评估、效益、筛查史和合并症个体化决策。 最佳实践建议 第六条：对于对CRC的平均风险的个体，筛查选项包括结肠镜检查、免疫化学大便试验、灵活乙状结肠镜检查加免疫化学大便试验、多重靶大便DNA免疫化学大便试验和计算机断层摄像头结肠镜检查，选择应基于其可用性和个体偏好。 最佳实践建议 第七条：对于CRC风险增加的个体，结肠镜检查应是筛查策略。 最佳实践建议 第八条：年龄大于75岁的个体是否继续进行息肉切除后的监测应根据风险评估、效益和合并症个体化决策。 最佳实践建议 第九条：从研究中产生的对CRC筛查和息肉切除后的监测进行风险分层的工具应在各种人群（例如种族、民族、性别和与CRC结果不平等相关的其他社会人口学因素）中进行真实世界的有效性和经济性评估，然后再广泛实施。 版权 © 2023年作者。由Elsevier公司出版。保留所有权利。

Since the early 2000s, there has been a rapid decline in colorectal cancer (CRC) mortality, due in large part to screening and removal of precancerous polyps. Despite these improvements, CRC remains the second leading cause of cancer deaths in the United States, with approximately 53,000 deaths projected in 2023. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review was to describe how individuals should be risk-stratified for CRC screening and post-polypectomy surveillance and to highlight opportunities for future research to fill gaps in the existing literature.This Expert Review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: All individuals with a first-degree relative (defined as a parent, sibling, or child) who was diagnosed with CRC, particularly before the age of 50 years, should be considered at increased risk for CRC. BEST PRACTICE ADVICE 2: All individuals without a personal history of CRC, inflammatory bowel disease, hereditary CRC syndromes, other CRC predisposing conditions, or a family history of CRC should be considered at average risk for CRC. BEST PRACTICE ADVICE 3: Individuals at average risk for CRC should initiate screening at age 45 years and individuals at increased risk for CRC due to having a first-degree relative with CRC should initiate screening 10 years before the age at diagnosis of the youngest affected relative or age 40 years, whichever is earlier. BEST PRACTICE ADVICE 4: Risk stratification for initiation of CRC screening should be based on an individual's age, a known or suspected predisposing hereditary CRC syndrome, and/or a family history of CRC. BEST PRACTICE ADVICE 5: The decision to continue CRC screening in individuals older than 75 years should be individualized, based on an assessment of risks, benefits, screening history, and comorbidities. BEST PRACTICE ADVICE 6: Screening options for individuals at average risk for CRC should include colonoscopy, fecal immunochemical test, flexible sigmoidoscopy plus fecal immunochemical test, multitarget stool DNA fecal immunochemical test, and computed tomography colonography, based on availability and individual preference. BEST PRACTICE ADVICE 7: Colonoscopy should be the screening strategy used for individuals at increased CRC risk. BEST PRACTICE ADVICE 8: The decision to continue post-polypectomy surveillance for individuals older than 75 years should be individualized, based on an assessment of risks, benefits, and comorbidities. BEST PRACTICE ADVICE 9: Risk-stratification tools for CRC screening and post-polypectomy surveillance that emerge from research should be examined for real-world effectiveness and cost-effectiveness in diverse populations (eg, by race, ethnicity, sex, and other sociodemographic factors associated with disparities in CRC outcomes) before widespread implementation.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.