Improving Endoscopic Detection of Dysplasia in Inflammatory Bowel Disease: Where Do We Stand?
Patients with inflammatory bowel disease (IBD) involving the colon are at increased risk of developing colorectal cancer. Surveillance colonoscopy to detect dysplasia and early colorectal cancer is therefore one of the key elements of health care maintenance in IBD patients. In general, patients with left-sided or extensive colitis should have surveillance exams every 1–2 years starting 8 years after diagnosis. Dysplasia surveillance has typically involved taking four-quadrant random biopsies throughout the colon. However, numerous studies have demonstrated that targeted examination using chromoendoscopy (CE) increases the detection of dysplastic lesions compared to standard-definition white-light colonoscopy and is recommended by the SCENIC international consensus statement. CE is an enhanced visualization technique that involves spraying the colon with a contrast dye, typically methylene blue or indigo carmine. It remains to be definitively determined if CE is better than high-definition white-light colonoscopy and if removing lesions detected by CE leads to meaningful changes in long-term management and colorectal cancer risk.
KeywordsInflammatory bowel disease Dysplasia Colitis-associated neoplasia Endoscopy Chromoendoscopy
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