Endoscopic surveillance of colorectal cancer in inflammatory bowel diseases: a review of the literature

ABSTRACT

Introduction

The risk of colorectal cancer (CRC) in patients with inflammatory bowel diseases (IBD) is higher compared to the general population and it is related to the type, severity, duration, and extension of the disease.

Areas covered

This review aims to highlight current evidence from the literature supporting the role of endoscopic surveillance of CRC in patients with IBD.

Expert opinion

Even in the absence of randomized controlled trials (RCTs), evidence from the literature supports the effectiveness of endoscopic surveillance in reducing IBD-related CRC incidence and mortality. As a consequence, current guidelines recommend colonoscopy 8–10 years after disease or symptom onset in all patients with ulcerative colitis (UC) and Crohn’s disease (CD) involving at least one-third of the colon and agree on the necessity of annual surveillance in high-risk patients. Nevertheless, an overall agreement on the optimal intervals for surveillance of low-intermediate risk patients is absent and 2–5 year intervals have been proposed. In the near future, further studies are needed to assess the most effective intervals and tailor the surveillance based on the personal risk profile. Additionally, further efforts should be made to evaluate the role of noninvasive tests as primary screening, thus avoiding unnecessary colonoscopies.

KEYWORDS:

• Colorectal cancer
• IBD
• ulcerative colitis
• Crohn’s disease
• surveillance
• colonoscopy

Article highlights

• CRC risk in IBD patients is related to the type, severity, extension, and duration of the disease, and patients with extensive colitis have the greatest CRC risk.

• Most international guidelines recommend beginning surveillance with colonoscopy and biopsy mapping 8-10 years after disease or symptom onset in all patients with UC and CD involving at least one-third of the colon.

• All guidelines agree on the necessity of annual surveillance for high-risk patients. An overall agreement for surveillance of low-intermediate risk patients is absent and 2 to 5 year intervals have been proposed.

• In patients with IPAA, yearly pouchoscopy is recommended for patients with high-risk features (e.g. history of PSC, previous dysplasia or CRC, severely inflamed atrophic pouch mucosa), while 5-year intervals are suggested for those without risk factors.

• The combination of CE and Tb provides high accuracy for the detection of dysplasia. High-definition WLE with Tb and Rb may represent an alternative approach. Currently, recent data of literature do not show any advantage of CE over high-definition WLE.

• In the case of polypoid sessile dysplastic lesions removed by piecemeal or by en-block EMR or ESD techniques, ECCO guidelines recommend surveillance with CE at 3 months and then at least annually, whereas US Multi-Society guidelines suggest 1 to 6 months follow-up and subsequent longer surveillance intervals in the case of a negative result at the subsequent colonoscopy.

• For invisible LGD at Rb confirmed by an expert gastrointestinal pathologist, colectomy is suggested when multifocal by CCFA, ASGE, and CCA guidelines, while AGA, ACG, BSG, ECCO guidelines advice to consider colectomy vs. intensified surveillance as for unifocal invisible LGD.

• For invisible HGD, the AGA, ACG, ASGE, ECCO and CCA guidelines recommend colectomy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this paper is listed as an inventor on intellectual property licensed to Exact Sciences by Mayo Clinic.

Additional information

Funding

This paper received no funding.