Colonoscopic Surveillance in Inflammatory Bowel Disease

Thomas A Ullman

Disclosures

Curr Opin Gastroenterol. 2005;21(5):585-588. 

In This Article

Abstract and Introduction

Purpose of Review: To describe recent findings in the literature aimed at decreasing systematic error in dysplasia surveillance in inflammatory bowel disease.
Recent Findings: Despite great promise, colonoscopic surveillance in inflammatory bowel disease has yet to be demonstrated to reduce colorectal cancer mortality. In part, this stems from a number of inherent systematic troubles, including low rates of observer agreement among pathologists; lack of consensus on the natural history of dysplasia, particularly low-grade dysplasia; the patchy nature of dysplasia, which leads to sampling error caused by insufficient biopsy by endoscopists; and incomplete patient follow-up. Recent publications that have focused on defining better the natural history of different levels of dysplasia and improving dysplasia identification at the time of colonoscopy may aid in overcoming the flaws of surveillance. The key recent findings include conflicting evidence on the relative danger of flat low-grade dysplasia, the safety of treating polypoid low-grade dysplasia as a benign adenoma in the absence of flat dysplasia in the rest of the colon or the surrounding mucosa, and preliminary support of chromoendoscopy to target dysplasia better during colonoscopy and to limit unnecessary nontargeted biopsies.
Summary: These and other advances stand a reasonable chance of making surveillance a more accurate tool to discriminate between patients with chronic colitis likely to progress to advanced pathology and those less likely to do so. Such advances may result in effective surveillance in which both colorectal cancer mortality and unnecessary colectomy may be limited.

Although the association between longstanding idiopathic inflammatory bowel disease involving the colon and colorectal cancer (CRC) is well understood, endoscopic practice has thus far been limited to periodic colonoscopy with nontargeted biopsies to determine the degree and location of dysplasia, defined as unequivocal neoplasia. Such examinations have yet to be demonstrated to reduce CRC mortality in either ulcerative colitis or Crohn's colitis. Recently, a number of advances have been described that might lead to more uniform practice of surveillance and better discrimination between those likely to progress to more advanced pathology and those likely to remain CRC-free. This review summarizes some of these advances.

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