Journal
UNITED EUROPEAN GASTROENTEROLOGY JOURNAL
Volume 10, Issue 10, Pages 1054-1062Publisher
JOHN WILEY & SONS LTD
DOI: 10.1002/ueg2.12330
Keywords
colon; colonoscopy; colorectal cancer; EMR; ESD; inflammation; inflammatory bowel disease; ulcerative colitis
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Patients with longstanding extensive colitis are at increased risk of developing colorectal cancer. Current surveillance programs have limitations and managing dysplastic lesions can be challenging. This review discusses the diagnosis, detection techniques, and a standardized multi-disciplinary approach to managing patients with dysplasia in inflammatory bowel disease.
Patients with longstanding extensive colitis are at an increased risk of developing colorectal cancer (CRC), and are therefore enrolled into colonoscopy screening programmes with the aim of detecting pre-cancerous dysplastic change. However, current surveillance programs face multiple limitations relating to low levels of patient enrolment, missed lesions resulting in interval cancers, and uncertainties in the management of dysplasia. Patient counselling regarding the endoscopic and surgical management options of dysplastic lesions can prove particularly challenging, due to the variable risk of progression to cancer. In this review, we discuss the histopathological diagnosis of inflammatory bowel disease (IBD)-associated dysplasia, describe the techniques to maximise dysplasia detection, and present a standardised multi-disciplinary approach to managing patients with dysplasia. The challenges presented by this patient cohort highlight the clear clinical need for further research into the development and validation of non-invasive markers of CRC risk in IBD patients undergoing surveillance.
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