Neoplasia in inflammatory bowel disease: surveillance and management strategies

Dysplasia surveillance remains the standard approach to minimize colorectal cancer (CRC) risk and morbidity in inflammatory bowel disease. Approaches to treatment in Crohn's disease are generally similar to those for ulcerative colitis. Recently the addition of dye spraying onto the colon to facilitate targeted biopsy has become increasingly associated with enhanced dysplasia surveillance; however, random biopsies are mostly still undertaken, even by those endoscopists who use chromoendoscopy. The prevailing literature continues to support colectomy for any degree of dysplasia. However, for those with adenoma-like masses, ongoing surveillance after polypectomy could still be considered appropriate. Certain endoscopic features are associated with increased incidence of neoplasia. These include not only strictures but also pseudopolyps. Past corticosteroid use and more than one screening colonoscopy were associated in two large case-control studies with reduced incidence of CRC. Although great interest has been expressed in the possible effectiveness of 5-aminosalicylic acid, it has not been proved to be an effective chemopreventive agent.