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Colon cancer screening and surveillance in inflammatory bowel disease.

Bae SI, Kim YS - Clin Endosc (2014)

Bottom Line: For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter.The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD.A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Accordingly, the duration and anatomic extent of the disease have been known to affect the development of IBD-related CRC. When CRC occurs in patients with IBD, unlike in sporadic CRC, it is difficult to detect the lesions because of mucosal changes caused by inflammation. In addition, the tumor types vary with ill-circumscribed lesions, and the cancer is difficult to diagnose and remedy at an early stage. For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter. The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD. A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected. Currently, pharmacotherapies are being extensively studied as a way to prevent IBD-related CRC.

No MeSH data available.


Related in: MedlinePlus

A nonadenoma-like dysplasia-associated lesion or mass seen during colon cancer screening in a patient with long-standing ulcerative colitis. Images during conventional (A) white light endoscopy and (B) chromoendoscopy.
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Figure 1: A nonadenoma-like dysplasia-associated lesion or mass seen during colon cancer screening in a patient with long-standing ulcerative colitis. Images during conventional (A) white light endoscopy and (B) chromoendoscopy.

Mentions: Multiple colon biopsies are often required for CRC surveillance because dysplasia in patients with IBD is flat and multifocal, making it difficult to detect grossly. As a standard method for the detection of IBD-related CRC, random 4-quadrant biopsies with regular 10-cm intervals have been recommended for at least 33 different regions of the entire colon34 in addition to biopsy of areas with mucosal irregularity.35 However, in random biopsies, less than 1% of the entire mucosal surface of the colon is sampled, leaving a very high sampling error36 and yielding a low positive rate, while also being expensive and time-consuming. Chromoendoscopy, a technique that uses dyes such as indigo carmine and methylene blue sprayed on the colonic mucosa, can provide improved visualization of fine mucosal changes when compared with conventional white light endoscopy (Fig. 1). The dysplasia detection rate is reportedly 2.0% to 8.8% in conventional white light endoscopy compared with 7.0% to 16.7% in chromoendoscopy, indicating that the latter is two to three times better at detecting dysplasia.37,38,39,40,41 Although additional time is required for the dye spraying, no time disparities occur between the two methods because of the reduced frequency of biopsies needed with chromoendoscopy relative to the random biopsy approach. The Guidelines of the British Society of Gastroenterology, updated in 2010, recommend pancolonic dye spraying with targeted biopsies of any abnormal areas.29


Colon cancer screening and surveillance in inflammatory bowel disease.

Bae SI, Kim YS - Clin Endosc (2014)

A nonadenoma-like dysplasia-associated lesion or mass seen during colon cancer screening in a patient with long-standing ulcerative colitis. Images during conventional (A) white light endoscopy and (B) chromoendoscopy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260098&req=5

Figure 1: A nonadenoma-like dysplasia-associated lesion or mass seen during colon cancer screening in a patient with long-standing ulcerative colitis. Images during conventional (A) white light endoscopy and (B) chromoendoscopy.
Mentions: Multiple colon biopsies are often required for CRC surveillance because dysplasia in patients with IBD is flat and multifocal, making it difficult to detect grossly. As a standard method for the detection of IBD-related CRC, random 4-quadrant biopsies with regular 10-cm intervals have been recommended for at least 33 different regions of the entire colon34 in addition to biopsy of areas with mucosal irregularity.35 However, in random biopsies, less than 1% of the entire mucosal surface of the colon is sampled, leaving a very high sampling error36 and yielding a low positive rate, while also being expensive and time-consuming. Chromoendoscopy, a technique that uses dyes such as indigo carmine and methylene blue sprayed on the colonic mucosa, can provide improved visualization of fine mucosal changes when compared with conventional white light endoscopy (Fig. 1). The dysplasia detection rate is reportedly 2.0% to 8.8% in conventional white light endoscopy compared with 7.0% to 16.7% in chromoendoscopy, indicating that the latter is two to three times better at detecting dysplasia.37,38,39,40,41 Although additional time is required for the dye spraying, no time disparities occur between the two methods because of the reduced frequency of biopsies needed with chromoendoscopy relative to the random biopsy approach. The Guidelines of the British Society of Gastroenterology, updated in 2010, recommend pancolonic dye spraying with targeted biopsies of any abnormal areas.29

Bottom Line: For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter.The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD.A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Accordingly, the duration and anatomic extent of the disease have been known to affect the development of IBD-related CRC. When CRC occurs in patients with IBD, unlike in sporadic CRC, it is difficult to detect the lesions because of mucosal changes caused by inflammation. In addition, the tumor types vary with ill-circumscribed lesions, and the cancer is difficult to diagnose and remedy at an early stage. For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter. The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD. A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected. Currently, pharmacotherapies are being extensively studied as a way to prevent IBD-related CRC.

No MeSH data available.


Related in: MedlinePlus