Surveillance and Management of dysplasia in Inflammatory bowel disease: Guidelines
Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine. Crohn's disease and ulcerative colitis are the principal types of inflammatory bowel disease. It is important to note that not only does Crohn's disease affect the small intestine and large intestine, it can also affect the mouth, esophagus, stomach and the anus whereas ulcerative colitis primarily affects the colon and the rectum.
Patients with ulcerative colitis or Crohn’s colitis have an increased risk of colorectal cancer (CRC). Most cases are believed to arise from dysplasia, and surveillance colonos- copy therefore is recommended to detect dysplasia. Detec- tion of dysplasia traditionally has relied on both examination of the mucosa with targeted biopsies of visible lesions and extensive random biopsies to identify invisible dysplasia.
In March 2015, American Gastroenterological Association Institute issued guidelines on SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Following are its major recommendations :
Major Recommendations
Detection of Dysplasia on Surveillance Colonoscopy
- When performing surveillance with white light colonoscopy, high definition is recommended rather than standard definition (Strong recommendation, Low-quality evidence).
- When performing surveillance with standard definition colonoscopy, chromoendoscopy is recommended rather than white light colonoscopy (Strong recommendation, Moderate quality evidence).
- When performing surveillance with high definition colonoscopy, chromoendoscopy is suggested rather than white-light colonoscopy (Conditional recommendation, Low quality evidence).
- When performing surveillance with standard definition colonoscopy, narrow-band imaging is not suggested in place of white light colonoscopy (Conditional recommendation, Low quality evidence).
- When performing surveillance with high definition colonoscopy, narrow-band imaging is not suggested in place of white light colonoscopy (Conditional recommendation, Moderate quality evidence).
- When performing surveillance with image-enhanced high-definition colonoscopy, narrow-band imaging is not suggested in place of chromoendoscopy (Conditional recommendation, Moderate quality evidence).
Management of Dysplasia Discovered on Surveillance Colonoscopy
- After complete removal of endoscopically resectable polypoid dysplastic lesions, surveillance colonoscopy is recommended rather than colectomy (Strong recommendation, Very low-quality evidence).
- After complete removal of endoscopically resectable nonpolypoid dysplastic lesions, surveillance colonoscopy is suggested rather than colectomy (Conditional recommendation, Very low-quality evidence).
- For patients with endoscopically invisible dysplasia (confirmed by a gastrointestinal [GI] pathologist) referral is suggested to an endoscopist with expertise in inflammatory bowel disease (IBD) surveillance using chromoendoscopy with high definition colonoscopy (Conditional recommendation, Very low-quality evidence).
You can read the full Guideline by clicking on the following link :
Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R, SCENIC Guideline Development Panel. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc. 2015 Mar;81(3):489-501.e26. [106 references]PubMed
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