Highlights
- •Chronic inflammation predisposes patients with colonic IBD to develop CRC.
- •Surveillance enables early detection of dysplastic lesions and CRC.
- •Improved risk-stratification of IBD patients is required to optimise surveillance.
- •Dysplastic lesions are increasingly treated with endoscopic resection techniques.
- •Long-term follow-up studies after endoscopic resections of dysplasia are needed.
Abstract
Keywords
Abbreviations:
5-ASA (5-aminosalicilyc acid), CD (Crohn's disease), CRC (Colorectal cancer), EMR (Endoscopic mucosal resection), ESD (Endoscopic submucosal dissection), HD (High-definition), HGD (High-grade dysplasia), IBD (Inflammatory bowel disease), LGD (Low-grade dysplasia), pks (polyketide nonribosomal peptide synthase operon), PSC (Primary sclerosing cholangitis), RCT (Randomised controlled trial), TNF-alpha (Tumour necrosis factor-alpha), UC (Ulcerative colitis), UDCA (Ursodeoxycholic acid)1. Introduction
2. Pathophysiology
3. Epidemiology
3.1 Excess risk of CRC in patients with IBD
3.2 Risk factors
4. Surveillance
4.1 Surveillance strategies

4.2 Surveillance technique

4.3 Unmet needs
Nederlandse Vereniging van Maag-, Darm- en Leverartsen, Handleiding behandeling IBD - 2014-2015. (Accessed April 8, 2021, at https://www.mdl.nl/sites/www.mdl.nl/files/richlijnen/Document_volledig_Handleiding_met_literatuur_def.pdf).
5. Management of dysplasia
Endoscopic mucosal resection (EMR) | Endoscopic submucosal dissection (ESD) | |
---|---|---|
Resection plane | + Submucosa | + Submucosa |
Suitable lesions | - Smaller polypoid and non-polypoid lesions | + Large (>20mm), high-risk lesions |
and non-polypoid lesions | ||
Procedure time | + Relatively short | - Long |
Learning curve | + Relatively short | - Relatively long |
Adverse events | + Low | +/- Low, but higher than EMR |
Histopathological examination | - Difficult, due to frequent piecemeal resections | + Good, due to high rate of en bloc resections |
Radical (R0) resections rate | - Relatively low | + High |
6. Chemoprevention
7. Conclusion

Funding
Authors’ contributions
Declarations of Competing Interest
Appendix. Supplementary materials
References
- The sigmoidoscopic picture of chronic ulcerative colitis (non- specific).Am J Med Sci. 1925; 170: 220-228
- Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years.Gastroenterology. 2012; 143 (e1; quiz e13-4): 375-381
- Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies.Inflamm Bowel Dis. 2013; 19: 789-799
- ECCO-ESGAR guideline for diagnostic assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications.J Crohns Colitis. 2019; 13: 144-164
- British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.Gut. 2019; 68: s1-s106
- ACG clinical guideline: ulcerative colitis in adults.Am J Gastroenterol. 2019; 114: 384-413
- ACG clinical guideline: management of Crohn's disease in adults.Am J Gastroenterol. 2018; 113: 481-517
- AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease.Gastroenterology. 2010; 138: 738-745
- Strategies for detecting colorectal cancer in patients with inflammatory bowel disease: a cochrane systematic review and meta-analysis.Am J Gastroenterol. 2018; 113: 1801-1809
- Endoscopic submucosal dissection for visible dysplasia treatment in ulcerative colitis patients: cases series and systematic review of literature.J Crohns Colitis. 2021; 15: 165-168
- Biological therapies in inflammatory bowel disease: beyond anti-TNF therapies.Clin Immunol. 2019; 206: 9-14
- Next generation of small molecules in inflammatory bowel disease.Gut. 2017; 66: 199-209
- A genetic model for colorectal tumorigenesis.Cell. 1990; 61: 759-767
- Molecular biology of dysplasia and cancer in inflammatory bowel disease.Gastroenterol Clin North Am. 2006; 35: 553-571
- Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications.Hum Pathol. 1983; 14: 931-968
- Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study.Gut. 2019; 68: 414-422
- Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta-analysis.Gastroenterology. 2021; 160: 1584-1598
- Pan-colonic field defects are detected by CGH in the colons of UC patients with dysplasia/cancer.Cancer Lett. 2012; 320: 180-188
- Clinical implications of low grade dysplasia found during inflammatory bowel disease surveillance: a retrospective study comparing chromoendoscopy and white-light endoscopy.Endoscopy. 2017; 49: 161-168
- Association between indefinite dysplasia and advanced neoplasia in patients with inflammatory bowel diseases undergoing surveillance.Clin Gastroenterol Hepatol. 2020; 18 (e3): 1518-1527
- Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer.Am J Gastroenterol. 2015; 110 (quiz 1472): 1461-1471
- Molecular characterization of ulcerative colitis-associated colorectal carcinomas.Mod Pathol. 2020;
- IBD-Associated Dysplastic Lesions Show More Chromosomal Instability Than Sporadic Adenomas.Inflamm Bowel Dis. 2020; 26: 167-180
- Diagnostic utility of TP53 and cytokeratin 7 immunohistochemistry in idiopathic inflammatory bowel disease-associated neoplasia.Mod Pathol. 2014; 27: 303-313
- Overexpression of p53 predicts colorectal neoplasia risk in patients with inflammatory bowel disease and mucosa changes indefinite for dysplasia.Gastroenterol Rep (Oxf). 2015; 3: 344-349
- Differences in gut microbiota in patients with vs without inflammatory bowel diseases: a systematic review.Gastroenterology. 2020; 158 (e1): 930-946
- Intestinal inflammation targets cancer-inducing activity of the microbiota.Science. 2012; 338: 120-123
- Mutational signature in colorectal cancer caused by genotoxic pks(+) E. coli.Nature. 2020; 580: 269-273
- Genomic aberrations after short-term exposure to colibactin-producing E. coli transform primary colon epithelial cells.Nat Commun. 2021; 12: 1003
- Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview.Am J Gastroenterol. 2015; 110: 1022-1034
- Risk of colorectal high-grade dysplasia and cancer in a prospective observational cohort of patients with inflammatory bowel disease.Gastroenterology. 2013; 145 (e8): 166-175
- Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study.Lancet. 2020; 395: 123-131
- Colorectal cancer in Crohn's disease: a Scandinavian population-based cohort study.Lancet Gastroenterol Hepatol. 2020; 5: 475-484
- Survival of colorectal cancer in patients with or without inflammatory bowel disease: a meta-analysis.Dig Dis Sci. 2016; 61: 881-889
- Root-cause analyses of missed opportunities for the diagnosis of colorectal cancer in patients with inflammatory bowel disease.Aliment Pharmacol Ther. 2021; 53: 291-301
- Long-term follow-up reveals low incidence of colorectal cancer, but frequent need for resection, among Australian patients with inflammatory bowel disease.Clin Gastroenterol Hepatol. 2014; 12: 644-650
- Incidence and classification of postcolonoscopy colorectal cancers in inflammatory bowel disease: a dutch population-based cohort study.J Crohns Colitis. 2018; 12: 777-783
- High risk of advanced colorectal neoplasia in patients with primary sclerosing cholangitis associated with inflammatory bowel disease.Clin Gastroenterol Hepatol. 2018; 16 (e3): 1106-1113
- Primary sclerosing cholangitis.N Engl J Med. 2016; 375: 1161-1170
- Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis.Gastroenterology. 1991; 100: 1319-1323
- A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines.Gastrointest Endosc. 2014; 80: 842-848
- Incidence of interval colorectal cancer among inflammatory bowel disease patients undergoing regular colonoscopic surveillance.Clin Gastroenterol Hepatol. 2015; 13: 1656-1661
- Letter: colorectal cancer surveillance in inflammatory bowel disease-a call for systematic reform.Aliment Pharmacol Ther. 2021; 53: 953-954
- Editorial: missed opportunities to detect colorectal cancer in inflammatory bowel disease-getting to the root.Aliment Pharmacol Ther. 2021; 53: 335-336
- Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men.Gastroenterology. 2016; 150 (quiz e14-5): 396-405
- SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease.Gastroenterology. 2015; 148 (e28): 639-651
- The use of chromoendoscopy for surveillance of inflammatory bowel disease.VideoGIE. 2018; 3: 35-42
- Chromoendoscopy for surveillance in ulcerative colitis and crohn's disease: a systematic review of randomized trials.Clin Gastroenterol Hepatol. 2017; 15 (e11): 1684-1697
- Meta-analysis of dye-based chromoendoscopy compared with standard- and high-definition white-light endoscopy in patients with inflammatory bowel disease at increased risk of colon cancer.Gastrointest Endosc. 2019; 90 (e1): 186-195
- Surveillance in inflammatory bowel disease: is chromoendoscopy the only way to go? A systematic review and meta-analysis of randomized clinical trials.Endosc Int Open. 2020; 8: E578-E590
- High-definition chromoendoscopy superior to high-definition white-light endoscopy in surveillance of inflammatory bowel diseases in a randomized trial.Clin Gastroenterol Hepatol. 2020; 18: 2101-2107
- Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?.Gut. 2018; 67: 616-624
- Comparison of targeted vs random biopsies for surveillance of ulcerative colitis-associated colorectal cancer.Gastroenterology. 2016; 151: 1122-1130
- A 1-year cross-sectional inflammatory bowel disease surveillance colonoscopy cohort comparing high-definition white light endoscopy and chromoendoscopy.Inflamm Bowel Dis. 2021; 27: 594-602
- Random biopsies during surveillance colonoscopy increase dysplasia detection in patients with primary sclerosing cholangitis and ulcerative colitis.J Crohns Colitis. 2013; 7: 974-981
- Consecutive negative findings on colonoscopy during surveillance predict a low risk of advanced neoplasia in patients with inflammatory bowel disease with long-standing colitis: results of a 15-year multicentre, multinational cohort study.Gut. 2019; 68: 615-622
Nederlandse Vereniging van Maag-, Darm- en Leverartsen, Handleiding behandeling IBD - 2014-2015. (Accessed April 8, 2021, at https://www.mdl.nl/sites/www.mdl.nl/files/richlijnen/Document_volledig_Handleiding_met_literatuur_def.pdf).
- Fecal hemoglobin and calprotectin are equally effective in identifying patients with inflammatory bowel disease with active endoscopic inflammation.Inflamm Bowel Dis. 2014; 20: 307-314
- European consensus on the histopathology of inflammatory bowel disease.J Crohns Colitis. 2013; 7: 827-851
- Interobserver variability in the diagnosis of ulcerative colitis-associated dysplasia by telepathology.Mod Pathol. 2002; 15: 379-386
- Misclassification of dysplasia in patients with inflammatory bowel disease: consequences for progression rates to advanced neoplasia.Inflamm Bowel Dis. 2011; 17: 1108-1116
- Histological evaluation in ulcerative colitis.Gastroenterol Rep (Oxf). 2014; 2: 178-192
- ECCO topical review optimising reporting in surgery, endoscopy, and histopathology.J Crohns Colitis. 2021;
- Curative endoscopic submucosal dissection of large nonpolypoid superficial neoplasms in ulcerative colitis (with videos).Gastrointest Endosc. 2015; 82: 734-738
- AGA institute clinical practice update: endoscopic submucosal dissection in the United States.Clin Gastroenterol Hepatol. 2019; 17 (e1): 16-25
- European evidence based consensus on surgery for ulcerative colitis.J Crohns Colitis. 2015; 9: 4-25
- ECCO-ESCP consensus on surgery for Crohn's disease.J Crohns Colitis. 2018; 12: 1-16
- Malignant and nonmalignant complications of the rectal stump in patients with inflammatory bowel disease.Inflamm Bowel Dis. 2019; 25: 377-384
- Systematic review: outcomes and post-operative complications following colectomy for ulcerative colitis.Aliment Pharmacol Ther. 2016; 44: 807-816
- The relation between disease activity, quality of life and health utility in patients with ulcerative colitis.Gut. 2008; (57[Suppl 1]:A153-4)
- Systematic review with meta-analysis: use of 5-aminosalicylates and risk of colorectal neoplasia in patients with inflammatory bowel disease.Aliment Pharmacol Ther. 2017; 45: 1179-1192
- Chemopreventive effects of 5-aminosalicylic acid on inflammatory bowel disease-associated colorectal cancer and dysplasia: a systematic review with meta-analysis.Oncotarget. 2017; 8: 1031-1045
- Peyrin-Biroulet L. 5-Aminosalicylic acid and chemoprevention: does it work?.Dig Dis. 2013; 31: 248-253
- Prognostic factors for advanced colorectal neoplasia in inflammatory bowel disease: systematic review and meta-analysis.Gastroenterology. 2020;
- Reduced risk of inflammatory bowel disease-associated colorectal neoplasia with use of thiopurines: a systematic review and meta-analysis.J Crohns Colitis. 2018; 12: 546-558
- Systematic review with meta-analysis: thiopurines decrease the risk of colorectal neoplasia in patients with inflammatory bowel disease.Aliment Pharmacol Ther. 2018; 47: 318-331
- Effect of ursodeoxycholic acid use on the risk of colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease: a systematic review and meta-analysis.Inflamm Bowel Dis. 2013; 19: 1631-1638
- High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis.Hepatology. 2009; 50: 808-814
- High-dose ursodeoxycholic acid is associated with the development of colorectal neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis.Am J Gastroenterol. 2011; 106: 1638-1645
- British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis.Gut. 2019; 68: 1356-1378
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