A Proximal Ascending Colon Lesion of a Crohn Disease Patient

Arthur M. Barrie, MD, PhD


August 13, 2015


Those with ulcerative colitis or Crohn colitis, such as the patient in this case, have an increased risk of developing colorectal cancer.[3] Though recent studies suggest that this risk is not as great as was once thought, it is still significant, with one prominent study estimating the risk in ulcerative colitis to be 1%, 2%, and 5% after 10, 20, and greater than 20 years of disease, respectively.[4] Patient and disease factors that have been associated with increased risk for colorectal cancer in IBD include young age at disease onset, male sex, extent/duration/severity of disease, presence of pseudopolyps and strictures, family history of colorectal cancer, and coexisting primary sclerosing cholangitis.[3,5]

A significant percentage of colonic neoplasms in IBD are flat dysplastic lesions or NP-CRN.[1,6] In the past, these lesions were frequently characterized endoscopically as dysplasia-associated lesions or masses, but authorities now recommend that term be abandoned because of prior inconsistencies. Instead, they recommend that these lesions be classified as either polypoid or nonpolypoid.[7] Given that NP-CRN are nonprotruding, they can be difficult to identify and/or completely resect on white-light colonoscopy. This predisposes patients to a relatively high rate of interval colorectal cancer, which may account for up to 50% of colorectal cancer in patients with IBD.[6] Factors that enhance the detection of NP-CRN during surveillance colonoscopy include excellent bowel preparation, quiescent mucosal disease, and the use of high-definition colonoscopy.

In retrospect, performing a timely follow-up surveillance colonoscopy in the patient in this case once he achieved clinical remission was key to the early detection of his NP-CRN. And though not used in this case, chromoendoscopy is suggested rather than white-light high-definition colonoscopy alone.

The SCENIC international consensus statement, published this year, offers more information on the surveillance and management of dysplasia in IBD.[8]

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