Crohn's colitis versus ulcerative colitis: should surveillance for dysplasia and cancer differ?

Although the risk of developing dysplasia and carcinomas in the colon is known to increase over time in patients with ulcerative colitis, data are scarce on the need for surveillance colonoscopies in patients with long-standing Crohn's colitis. This article discusses the results of a study by Friedman et al. conducted in 259 patients with chronic Crohn's colitis who received a median of four follow-up colonoscopies over 25 years after an initial negative examination result for dysplasia or carcinomas. The cumulative risk for developing dysplasia or carcinomas has only increased from 22% to 25% in the 10 years since the previous report from this study's authors, and the prevalence of extensive colitis was higher in study participants than that expected in a random population of patients with Crohn's colitis. However, Friedman et al. provide convincing evidence that long-term surveillance for the development of colonic dysplasia and cancers is advantageous in this population.