Colonoscopic surveillance in inflammatory bowel disease

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Colonoscopic surveillance in inflammatory bowel disease (IBD) has not yet proven effective in reducing colorectal cancer mortality.
• Systematic errors in IBD dysplasia surveillance include low inter-observer agreement, unclear dysplasia natural history, sampling errors, and incomplete follow-up.

Purpose of the Study:

• To review recent literature on strategies to decrease systematic error in dysplasia surveillance for patients with inflammatory bowel disease.
• To highlight advances that may improve the accuracy and efficacy of IBD surveillance protocols.

Main Methods:

• Literature review of recent publications on IBD dysplasia surveillance.
• Analysis of findings related to dysplasia natural history, detection methods, and patient management.

Main Results:

• Conflicting evidence exists regarding the risk associated with flat low-grade dysplasia.
• Polypoid low-grade dysplasia may be safely managed as adenoma if flat dysplasia is absent.
• Chromoendoscopy shows promise for targeted dysplasia detection and reducing unnecessary biopsies.

Conclusions:

• Recent advances offer potential to enhance surveillance accuracy in distinguishing IBD patients at high risk for advanced pathology.
• Improved surveillance may lead to reduced colorectal cancer mortality and fewer unnecessary colectomies.