Endoscopic detection and resection of dysplasia in inflammatory bowel disease-techniques with videos
- 124 Downloads
Patients with ulcerative colitis and Crohn’s colitis have an increased risk of developing dysplasia and colorectal cancer as compared to the general population; surveillance colonoscopy is recommended in this patient population.
This review of the published literature aimed to assess the published evidence.
Detection of dysplasia requires examination of mucosa with targeted biopsies of the visible lesions as well as random biopsies to detect invisible lesions. Newer endoscopic techniques, in particular chromoendoscopy, increase the yield of identifying dysplastic lesions. The surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients International Consensus (SCENIC) guidelines recommends that colonoscopy using chromoendoscopy is the optimal endoscopic surveillance strategy to detect dysplasia. Once dysplastic lesions are discovered on surveillance endoscopic examination, careful and meticulous descriptions of lesions is mandatory to aid in further decision making. Management of dysplastic lesions in inflammatory bowel disease patients depends on endoscopic (morphological) and histologic findings and patient characteristics such as age, general condition of the patient, and patient preferences. Endoscopic mucosal resection, endoscopic submucosal dissection, and surgery are different therapeutic options for colonic dysplastic lesions detected in the setting of inflammatory bowel disease.
In this review, we discuss the various techniques for endoscopic resection of dysplasia in patients with inflammatory bowel disease. Further research is required to determine the optimal approach to diagnosis and management of dysplasia in patients with inflammatory bowel disease.
KeywordsChromoendoscopy Dysplasia Endoscopic mucosal resection Inflammatory bowel disease Ulcerative colitis
Study concept, design, and critical revisions—B Shen and U Navaneethan
Paper preparation and revisions—S Khalid, N Khetpal, and A Abbass
Compliance with ethical standards
Conflict of interest
Udayakumar Navaneethan and Bo Shen are consultants for AbbVie. Udayakumar Navaneethan is on the speaker bureau for Takeda, AbbVie, Pfizer, and Janssen. None of the other authors declared financial conflict of interest.
- 4.Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S, on behalf of the IBD Section of the British Society of Gastroenterology (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut. 60:571–607CrossRefGoogle Scholar
- 14.Rubin DT, Huo D, Kinnucan JA, Sedrak MS, McCullom NE, Bunnag AP, Raun–Royer EP, Cohen RD, Hanauer SB, Hart J, Turner JR (2013) Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case-control study. Clin Gastroenterol Hepatol 11:1601–1608CrossRefGoogle Scholar
- 16.Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981CrossRefGoogle Scholar
- 18.Howdle P, Atkin W, Rutter M (2011) Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas. In: National Institute for Health and Clinical Excellence (NICE) clinical guideline 118. National Institute for Health and Clinical Excellence, LondonGoogle Scholar
- 23.Jess T, Loftus EV Jr, Velayos FS, Harmsen WS, Zinsmeister AR, Smyrk TC, Schleck CD, Tremaine WJ, Melton LJ III, Munkholm P, Sandborn WJ (2006) Risk of intestinal cancer in inflammatory bowel disease: a population-based study from Olmsted County, Minnesota. Gastroenterology 130:1039–1046CrossRefGoogle Scholar
- 25.Leighton JA, Shen B, Baron TH, Adler DG, Davila R, Egan JV, Faigel DO, Gan SI, Hirota WK, Lichtenstein D, Qureshi WA, Rajan E, Zuckerman MJ, VanGuilder T, Fanelli RD, Standards of Practice Committee, American Society for Gastrointestinal Endoscopy (2006) ASGE guidelines: endoscopy in the diagnosis and treatment of inflammatory bowel disease. Gastrointest Endosc 63:558–565CrossRefGoogle Scholar
- 29.Burgess NG, Hourigan LF, Zanati SA, Brown GJ, Singh R, Williams SJ, Raftopoulos SC, Ormonde D, Moss A, Byth K, Mahajan H, McLeod D, Bourke MJ (2017) Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicenter cohort. Gastroenterology. 153:732–742CrossRefGoogle Scholar
- 44.Annese V, Daperno M, Rutter MD, Amiot A, Bossuyt P, East J, Ferrante M, Götz M, Katsanos KH, Kießlich R, Ordás I, Repici A, Rosa B, Sebastian S, Kucharzik T, Eliakim R, European Crohn's and Colitis Organisation (2013) European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 7:982–1018CrossRefGoogle Scholar
- 45.Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, Eaden JA, Rutter MD, Atkin WP, Saunders BP, Lucassen A, Jenkins P, Fairclough PD, Woodhouse CR, British Society of Gastroenterology, Association of Coloproctology for Great Britain and Ireland (2010) Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 59:666–689CrossRefGoogle Scholar
- 47.Mahmoud R, Shah SC, Ten Hove JR et al (2018) No association between pseudopolyps and colorectal neoplasia in patients with inflammatory bowel diseases. Gastroenterology. https://doi.org/10.1053/j.gastro.2018.11.067
- 48.Moussata D, Allez M, Cazals-Hatem D et al (2017) Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy? Gut. https://doi.org/10.1136/gutjnl-2016-311892
- 49.Viera AJ (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–365Google Scholar
- 51.Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C, Gastrointestinal Consortium Panel (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology. 124:544–560CrossRefGoogle Scholar
- 52.Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R, East JE, Farraye FA, Feagan B, Ioannidis J, Kiesslich R, Krier M, Matsumoto T, McCabe RP, Mönkemüller K, Odze R, Picco M, Rubin DT, Rubin M, Rubio CA, Rutter MD, Sanchez-Yague A, Sanduleanu S, Shergill A, Ullman T, Velayos F, Yakich D, Yang YX (2015) SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology. 148:639–651CrossRefGoogle Scholar
- 56.Branquinho D, Portela F, Freire P, et al. (2016) P572 dysplasia in inflammatory bowel disease: is endoscopic mucosal resection ready for prime-time? 11th Congress of ECCO. AmsterdamGoogle Scholar
- 57.Navaneethan U, Feurer M, Villaneuva F, Glover S (2017) Impact of chromoendoscopy on outcomes in inflammatory bowel disease patients with a history of low grade dysplasia on white light endoscopy. Gastrointest Endosc 85:AB611Google Scholar
- 60.Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag HJ, Messmann H, Neuhaus H, Albers D, Birk M, Thimme R, Probst A, Faehndrich M, Frieling T, Goetz M, Riecken B, Caca K (2018) Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut. 67(7):1280–1289CrossRefGoogle Scholar
- 66.Iacucci M, McQuaid K, Gui XS, Iwao Y, Lethebe BC, Lowerison M, Matsumoto T, Shivaji UN, Smith SCL, Subramanian V, Uraoka T, Sanduleanu S, Ghosh S, Kiesslich R (2019) A multimodal (FACILE) classification for optical diagnosis of inflammatory bowel disease associated neoplasia. Endoscopy. 51:133–141CrossRefGoogle Scholar
- 67.Sugimoto S, Naganuma M, Iwao Y, Matsuoka K, Shimoda M, Mikami S, Mizuno S, Nakazato Y, Nanki K, Inoue N, Ogata H, Kanai T (2017) Endoscopic morphologic features of ulcerative colitis-associated dysplasia classified according to the SCENIC consensus statement. Gastrointest Endosc 85:639–646CrossRefGoogle Scholar