Colorectal cancer surveillance in inflammatory bowel disease: A critical analysis

Abstract

Colonoscopic surveillance is advocated in patients with inflammatory bowel disease (IBD) for detection of dysplasia. There are many issues regarding surveillance in IBD: the risk of colorectal cancer seems to be decreasing in the majority of recently published studies, necessitating revisions of surveillance strategy; surveillance guidelines are not based on concrete evidence; commencement and frequency of surveillance, cost-effectiveness and adherence to surveillance have been issues that are only partly answered. The traditional technique of random biopsy is neither evidence-based nor easy to practice. Therefore, highlighting abnormal areas with newer technology and biopsy from these areas are the way forward. Of the newer technology, digital mucosal enhancement, such as high-definition white light endoscopy and chromoendoscopy (with magnification) have been incorporated in guidelines. Dyeless chromoendoscopy (narrow band imaging) has not yet shown potential, whereas some forms of digital chromoendoscopy (i-Scan more than Fujinon intelligent color enhancement) have shown promise for colonoscopic surveillance in IBD. Other techniques such as autofluorescence imaging, endomicroscopy and endocytoscopy need further evidence. Surveillance with genetic markers (tissue, serum or stool) is at an early stage. This article discusses changing epidemiology of colorectal cancer development in IBD and critically evaluates issues regarding colonoscopic surveillance in IBD.

Keywords: Advanced imaging, Chromoendoscopy, Colorectal cancer, Colorectal cancer surveillance, Inflammatory bowel disease

Core tip: There is an increase in the risk of colorectal cancer in patients suffering from inflammatory bowel disease. Recent studies have suggested that this risk may be decreasing. In view of the risk, colonoscopic surveillance is recommended in order to detect cancer early. Instead of using previous methods of colonoscopy and random biopsy, newer technology such as chromoendoscopy and biopsy from abnormal mucosa is preferable.