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World J Gastroenterol. Jul 21, 2011; 17(27): 3184-3191
Published online Jul 21, 2011. doi: 10.3748/wjg.v17.i27.3184
Cancer risk in IBD: How to diagnose and how to manage DALM and ALM
Helmut Neumann, Michael Vieth, Cord Langner, Markus F Neurath, Jonas Mudter
Helmut Neumann, Markus F Neurath, Jonas Mudter, Department of Medicine 1, Department of Surgery, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
Michael Vieth, Institute of Pathology, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445 Bayreuth, Germany
Cord Langner, Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
Author contributions: Neumann H contributed to the study idea, study design, literature search, manuscript writing, and final revision of the article; Vieth M contributed to the study idea, study design, manuscript writing, and final revision of the article; Langner C and Neurath MF contributed to the writing of the manuscript and final revision of the article; Mudter J contributed to the study design, manuscript writing, and final revision of the article.
Correspondence to: Helmut Neumann, Professor, Department of Medicine 1, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany. helmut.neumann@uk-erlangen.de
Telephone: +49-9131-8535204 Fax: +49-9131-8535209
Received: August 14, 2010
Revised: March 1, 2011
Accepted: March 8, 2011
Published online: July 21, 2011
Abstract

The risk of developing neoplasia leading to colorectal cancer is significantly increased in ulcerative colitis (UC) and most likely in Crohn’s disease. Several endoscopic surveillance strategies have been implemented to identify these lesions. The main issue is that colitis-associated neoplasms often occurs in flat mucosa, often being detected on taking random biopsies rather than by identification of these lesions via endoscopic imaging. The standard diagnostic procedure in long lasting UC is to take four biopsies every 10 cm. Image enhancement methods, such as chromoendoscopy and virtual histology using endomicroscopy, have greatly improved neoplasia detection rates and may contribute to reduced random biopsies by taking targeted “smart” biopsies. Chromoendoscopy may effectively be performed by experienced endoscopists for routine screening of UC patients. By contrast, endomicroscopy is often only available in selected specialized endoscopic centers. Importantly, advanced endoscopic imaging has the potential to increase the detection rate of neoplasia whereas the interplay between endoscopic experience and interpretation of histological biopsy evaluation allows the physician to make a proper diagnosis and to find the appropriate therapeutic approach. Colitis-associated intraepithelial neoplasms may occur in flat mucosa of endoscopically normal appearance or may arise as dysplasia-associated lesion or mass (DALM), which may be indistinguishable from sporadic adenomas in healthy or non-colitis mucosa [adenoma-like mass (ALM)]. The aim of this review was to summarize endoscopic and histological characteristics of DALM and ALM in the context of therapeutic procedures.

Keywords: Inflammatory bowel disease; Crohn’s disease; Endoscopy; Colitis; Dysplasia-associated lesion or mass; Adenoma-like mass; Endomicroscopy; Ulcerative colitis; Endomicroscopy; Confocal laser endomicroscopy; Probe-based confocal laser endomicroscopy; Integrated confocal laser endomicroscopy; Endoscope-based confocal laser endomicroscopy; Narrow band imaging; Chromoendoscopy; Cancer; Dysplasia