Guidelines Clinical Practice
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jan 7, 2009; 15(1): 61-66
Published online Jan 7, 2009. doi: 10.3748/wjg.15.61
Colorectal cancer surveillance in inflammatory bowel disease: The search continues
Anis Ahmadi, Steven Polyak, Peter V Draganov
Anis Ahmadi, Steven Polyak, Peter V Draganov, Department of Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 SW Archer Rd, Room HD 602, PO Box 100214 Gainesville, Florida 32610, United States
Author contributions: Ahmadi A, Polyak S and Draganov PV designed the format; Ahmadi A performed the literature search and wrote the first draft of the paper; Polyak S and Draganov PV contributed new articles to the literature search and reviewed the article.
Correspondence to: Peter V Draganov, MD, Department of Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 SW Archer Rd, Room HD 602, PO Box 100214 Gainesville, Florida 32610, United States. dragapv@medicine.ufl.edu
Telephone: +1-352-392-2877
Fax: +1-352-392-3618
Received: August 8, 2008
Revised: October 17, 2008
Accepted: October 24, 2008
Published online: January 7, 2009
Abstract

Patients with inflammatory bowel disease (IBD) are at increased risk for colorectal cancer (CRC). Risk factors for the development of CRC in the setting of IBD include disease duration, anatomic extent of disease, age at time of diagnosis, severity of inflammation, family history of colon cancer, and concomitant primary sclerosing cholangitis. The current surveillance strategy of surveillance colonoscopy with multiple random biopsies most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, surveillance colonoscopy also has severe limitations including high cost, sampling error at time of biopsy, and interobserver disagreement in histologically grading dysplasia. Furthermore, once dysplasia is detected there is disagreement about its management. Advances in endoscopic imaging techniques are already underway, and may potentially aid in dysplasia detection and improve overall surveillance outcomes. Management of dysplasia depends predominantly on the degree and focality of dysplasia, with the mainstay of management involving either proctocolectomy or continued colonoscopic surveillance. Lastly, continued research into additional chemopreventive agents may increase our arsenal in attempting to reduce the incidence of IBD-associated CRC.

Keywords: Colorectal cancer; Crohn’s disease; Inflammatory bowel disease; Surveillance colonoscopy; Ulcerative colitis