An updated approach to dysplasia in IBD

Long-standing inflammation of the colorectum in ulcerative colitis (UC) and Crohn's disease (CD) has been associated with an increased risk of subsequent dysplasia and colorectal cancer. Historically, it was described that the neoplastic transformation in these inflammatory bowel diseases (IBDs) occurred via a different biologic pathway and not by the non-IBD polyp-cancer pathway and predictable lag time of progression. Therefore, prevention strategies have focused on the detection of dysplasia in flat mucosa, and existing guidelines have recommended performance of interval surveillance colonoscopies with random biopsies to identify such lesions with proctocolectomy when they are confirmed.

The use of a new technology higher-resolution colonoscopies has led to the appreciation more recently that dysplasia in IBD may be visible with standard optical colonoscopy and can be identified in an even more sensitive manner using chromoendoscopy. Furthermore, emerging evidence favors the intuitive understanding that neoplastic transformation in IBD is linked to the degree of inflammation and that disease control may therefore modify this risk and its subsequent prevention approaches.

Future IBD cancer prevention strategies and timing of surgery in at-risk patients will require a better understanding of this evolving field.