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Curriculum based clinical reviews
Curriculum review: colorectal cancer surveillance and management of dysplasia in IBD
  1. Hajir Ibraheim1,
  2. Angad Singh Dhillon1,
  3. Ioannis Koumoutsos1,
  4. Shraddha Gulati2,
  5. Bu’Hussain Hayee2
  1. 1IBD Centre, Guy’s and St Thomas’ Hospital, London, UK
  2. 2King’s Institute of Therapeutic Endoscopy, King’s College London, London, UK
  1. Correspondence to Dr Hajir Ibraheim, IBD Centre, Guy’s and St Thomas' Hospital, London SE1 9RT, UK; hajir.ibraheim{at}gmail.com

Abstract

The significantly increased risk of colorectal cancer (CRC) in longstanding colonic inflammatory bowel disease (IBD) justifies the need for endoscopic surveillance. Unlike sporadic CRC, IBD-related CRC does not always follow the predictable sequence of low-grade to high-grade dysplasia and finally to invasive carcinoma, probably because the genetic events shared by both diseases occur in different sequences and frequencies. Surveillance is recommended for patients who have had colonic disease for at least 8-10 years either annually, every 3 years or every 5 years with the interval dependant on the presence of additional risk factors. Currently, the recommended endoscopic strategy is high-definition chromoendoscopy with targeted biopsies, although the associated lengthier procedure time and need for experienced endoscopists has limited its uniform uptake in daily practice. There is no clear consensus on the management of dysplasia, which continues to be a challenging area particularly when endoscopically invisible. Management options include complete resection (and/or referral to a tertiary centre), close surveillance or proctocolectomy. Technical advances in endoscopic imaging such as confocal laser endomicroscopy, show exciting potential in increasing dysplasia detection rates but are still far from being routinely used in clinical practice.

  • inflammatory bowel disease
  • colonic neoplasms
  • dysplasia
  • endoscopic procedures

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Footnotes

  • Contributors HI: manuscript planning, writing, editing; submission, responsible for overall content. ASD, IK and SG: manuscript planning and editing. BH: manuscript planning, editing, provision of original images, responsible for overall content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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