Malignant transformation in inflammatory bowel disease - surveillance guide

Nowadays, it is considered as an established fact that patients with long-standing ulcerative colitis (UC) are at an increased risk of developing colorectal cancer (CRC). Although data for CRC risk in Crohn's disease (CD) are not as extensive, it has been suggested that the risks are comparable to UC. Current strategies for the prevention and early detection of cancer in this high-risk population are grounded in the concept of an inflammation-neoplasia-carcinoma sequence. To reduce CRC mortality in inflammatory bowel disease, colonoscopic surveillance with random and targeted biopsies were recommended to detect early neoplasia. The introduction of novel endoscopic techniques such as chromoendoscopy, narrow band imaging or confocal endomicroscopy to facilitate targeted biopsy has become increasingly associated with enhanced neoplasia detection. However, there is only indirect evidence that such surveillance strategies are likely to be effective at reducing the risk of death from inflammatory bowel disease-associated CRC. Further, new data revealed that surveillance strategies largely based upon disease duration delayed or missed a substantial number of patients with early CRC. Therefore, actual surveillance guidelines seem to be insufficient and need to be restructured.