Use and barriers to chromoendoscopy for dysplasia surveillance in inflammatory bowel disease

Table 1 Colorectal cancer surveillance guidelines for inflammatory bowel disease patients

Guideline (year of publication)	Timing of initiating surveillance	Surveillance interval	Biopsy protocol
AGA (2003)[4]	After 8 yr of disease (pancolitis) After 15 yr of disease (left-sided colitis)	1-2 yr	Random biopsy
BSG (2010)[46]	10 yr after onset of colitic symptoms	5 yr (lower risk)1 2-3 yr (intermediate risk) 1 yr (higher risk)	Targeted biopsy with CE (preferred) otherwise random biopsy
ECCO (2013)[6]	8 yr after onset of colitic symptoms	5 yr (lower risk)2 2-3 yr (intermediate risk) 1 yr (higher risk)	Targeted biopsy with CE (preferred), random biopsies if CE expertise unavailable
ASGE (2015)[7]	8 yr after symptom onset	1-3 yr (1 yr if any risk factor)3	Targeted biopsy with CE recommended with SD-WLE (preferred with HD-WLE as well); random biopsies with targeted biopsies of suspicious lesions is alternative

¹Higher risk group: Dysplasia in the past 5 years declining surgery, PSC/liver transplantation for PSC, family history of CRC in a first degree relative < 50 years, or extensive colitis with moderate/severe active endoscopic/histological inflammation; intermediate risk group: Post-inflammatory polyps, family history of CRC in a first degree relative > 50 years, extensive colitis with mild active endoscopic/histologic inflammation; lower risk group: Left sided colitis, Crohn’s colitis with less than 50% of the colonic mucosal surface affected by the disease, or extensive colitis with no active endoscopic/histologic inflammation;

²Higher risk group: Stricture or dysplasia in the past 5 years, PSC, extensive colitis with severe active inflammation, or family history of CRC in a first degree relative < 50 years; intermediate risk group: extensive colitis with mild or moderate active inflammation post-inflammatory polyps, or family history of CRC in a first degree relative > 50 years; lower risk group: Patients with neither intermediate nor higher risk features;

³Risk factors: Active inflammation, anatomic abnormality (stricture or multiple pseudopolyps), history of dysplasia, family history of CRC in a first degree relative, PSC. AGA: American gastroenterological association; BSG: British society of gastroenterology; ECCO: European crohn’s and colitis organisation; ASGE: American society of gastrointestinal endoscopy; PSC: Primary sclerosing cholangitis; CRC: Colorectal cancer; CE: Chromoendoscopy; SD-WLE: Standard definition white light endoscopy; HD-WLE: High definition white light endoscopy.