Minireviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2019; 25(30): 4148-4157
Published online Aug 14, 2019. doi: 10.3748/wjg.v25.i30.4148
Colorectal cancer surveillance in inflammatory bowel disease: Practice guidelines and recent developments
William T Clarke, Joseph D Feuerstein
William T Clarke, Joseph D Feuerstein, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
Author contributions: Clarke WT and Feuerstein JD performed the literature review and wrote the paper.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Joseph D Feuerstein, MD, Assistant Professor, Attending Doctor, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St 8E, Boston, MA 02215, United States. jfeuerst@bidmc.harvard.edu
Telephone: +1-617-6328623 Fax: +1-617-6329199
Received: May 5, 2019
Peer-review started: May 5, 2019
First decision: June 10, 2019
Revised: June 14, 2019
Accepted: July 2, 2019
Article in press: July 3, 2019
Published online: August 14, 2019
Processing time: 102 Days and 14.7 Hours
Abstract

Patients with long-standing inflammatory bowel disease (IBD) involving at least 1/3 of the colon are at increased risk for colorectal cancer (CRC). Advancements in CRC screening and surveillance and improved treatment of IBD has reduced CRC incidence in patients with ulcerative colitis and Crohn’s colitis. Most cases of CRC are thought to arise from dysplasia, and recent evidence suggests that the majority of dysplastic lesions in patients with IBD are visible, in part thanks to advancements in high definition colonoscopy and chromoendoscopy. Recent practice guidelines have supported the use of chromoendoscopy with targeted biopsies of visible lesions rather than traditional random biopsies. Endoscopists are encouraged to endoscopically resect visible dysplasia and only recommend surgery when a complete resection is not possible. New technologies such as virtual chromoendoscopy are emerging as potential tools in CRC screening. Patients with IBD at increased risk for developing CRC should undergo surveillance colonoscopy using new approaches and techniques.

Keywords: Inflammatory bowel disease; Colorectal cancer screening; Ulcerative colitis; Crohn’s disease; Colonoscopy; Chromoendoscopy

Core tip: The 2015 SCENIC guidelines provided updated recommendations on how to screen for colorectal cancer in patients with inflammatory bowel disease. These guidelines focused on the use of high definition colonoscopy and chromoendoscopy. There is ongoing debate and conflicting data as to whether white light endoscopy, chromoendoscopy or virtual chromoendoscopy should be the preferred method of surveillance and whether there is any benefit to random versus targeted biopsies. Visible dysplasia should be endoscopically resected when a complete resection is possible. Patients with special risk factors require a heightened surveillance protocol.