Improving Endoscopic Detection of Dysplasia in Inflammatory Bowel Disease: Where Do We Stand?

  • Ryan C. UngaroEmail author
  • James F. Marion


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.


Inflammatory bowel disease Dysplasia Colitis-associated neoplasia Endoscopy Chromoendoscopy 


  1. 1.
    Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48:526–35.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Greenstein AJ, Sachar DB, Smith H, Pucillo A, Papatestas AE, Kreel I, et al. Cancer in universal and left-sided ulcerative colitis: factors determining risk. Gastroenterology. 1979;77:290–4.PubMedGoogle Scholar
  3. 3.
    Jess T, Rungoe C, Peyrin-Biroulet L. Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol. 2012;10:639–45.CrossRefPubMedGoogle Scholar
  4. 4.
    Beaugerie L, Itzkowitz SH. Cancers complicating inflammatory bowel disease. N Engl J Med. 2015;373:195.PubMedGoogle Scholar
  5. 5.
    Rubin DT, Huo D, Kinnucan JA, Sedrak MS, McCullom NE, Bunnag AP, et al. Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case-control study. Clin Gastroenterol Hepatol. 2013;11:1601–8.e1.CrossRefPubMedGoogle Scholar
  6. 6.
    Gupta RB, Harpaz N, Itzkowitz S, Hossain S, Matula S, Kornbluth A, et al. Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study. Gastroenterology. 2007;133:1099–105. quiz 1340.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Annese V, Daperno M, Rutter MD, Amiot A, Bossuyt P, East J, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis. 2013;7:982–1018.CrossRefPubMedGoogle Scholar
  8. 8.
    Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:746–74. 774.e1.CrossRefPubMedGoogle Scholar
  9. 9.
    Centre for Clinical Practice at NICE (UK). Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, crohn’s disease or adenomas. National Institute for Health and Clinical Excellence: Guidance. London: National Institute for Health and Clinical Excellence (UK); 2011.Google Scholar
  10. 10.
    Choi C-HR, Rutter MD, Askari A, Lee GH, Warusavitarne J, Moorghen M, et al. Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview. Am J Gastroenterol. 2015;110:1022–34.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ananthakrishnan AN, Cagan A, Cai T, Gainer VS, Shaw SY, Churchill S, et al. Colonoscopy is associated with a reduced risk for colon cancer and mortality in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2015;13:322–329.e1.CrossRefPubMedGoogle Scholar
  12. 12.
    Rodriguez SA, Eisen GM. Surveillance and management of dysplasia in ulcerative colitis by U.S. gastroenterologists: in truth, a good performance. Gastrointest Endosc. 2007;66:1070.CrossRefPubMedGoogle Scholar
  13. 13.
    Awais D, Siegel CA, Higgins PDR. Modelling dysplasia detection in ulcerative colitis: clinical implications of surveillance intensity. Gut. 2009;58:1498–503.CrossRefPubMedGoogle Scholar
  14. 14.
    Van den Broek FJC, Stokkers PCF, Reitsma JB, Boltjes RPB, Ponsioen CY, Fockens P, et al. Random biopsies taken during colonoscopic surveillance of patients with longstanding ulcerative colitis: low yield and absence of clinical consequences. Am J Gastroenterol. 2014;109:715–22.CrossRefPubMedGoogle Scholar
  15. 15.
    Rutter MD, Saunders BP, Wilkinson KH, Kamm MA, Williams CB, Forbes A. Most dysplasia in ulcerative colitis is visible at colonoscopy. Gastrointest Endosc. 2004;60:334–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Rubin DT, Rothe JA, Hetzel JT, Cohen RD, Hanauer SB. Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis? Gastrointest Endosc. 2007;65:998–1004.CrossRefPubMedGoogle Scholar
  17. 17.
    Subramanian V, Ramappa V, Telakis E, Mannath J, Jawhari AU, Hawkey CJ, et al. Comparison of high definition with standard white light endoscopy for detection of dysplastic lesions during surveillance colonoscopy in patients with colonic inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:350–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology. 2015;148:639–651.e28.CrossRefPubMedGoogle Scholar
  19. 19.
    Naymagon S, Marion JF. Surveillance in inflammatory bowel disease: chromoendoscopy and digital mucosal enhancement. Gastrointest Endosc Clin N Am. 2013;23:679–94.CrossRefPubMedGoogle Scholar
  20. 20.
    Rutter MD, Saunders BP, Schofield G, Forbes A, Price AB, Talbot IC. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut. 2004;53:256–60.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Marion JF, Waye JD, Present DH, Israel Y, Bodian C, Harpaz N, et al. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol. 2008;103:2342–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Marion JF, Waye JD, Israel Y, Present DH, Suprun M, Bodian C, et al. Chromoendoscopy is more effective than standard colonoscopy in detecting dysplasia during long-term surveillance of patients with colitis. Clin Gastroenterol Hepatol. 2016;14:713–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Deepak P, Hanson GJ, Fletcher JG, Tremaine WJ, Pardi DS, Kisiel JB, et al. Incremental diagnostic yield of chromoendoscopy and outcomes in inflammatory bowel disease patients with a history of colorectal dysplasia on white-light endoscopy. Gastrointest Endosc. 2016;83:1005–12.CrossRefPubMedGoogle Scholar
  24. 24.
    Marion JF, Sands BE. The SCENIC consensus statement on surveillance and management of dysplasia in inflammatory bowel disease: praise and words of caution. Gastroenterology. 2015;148:462–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Ananthakrishnan AN. Chromoendoscopy is better: so why am I not (yet) using it for routine inflammatory bowel disease surveillance? Clin Gastroenterol Hepatol. 2016;14:720–2.CrossRefPubMedGoogle Scholar
  26. 26.
    Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY, Fidder HH, Siersema PD, Dekker E, et al. Chromoendoscopy for surveillance in inflammatory bowel disease does not increase neoplasia detection compared with conventional colonoscopy with random biopsies: results from a large retrospective study. Am J Gastroenterol. 2015;110:1014–21.CrossRefPubMedGoogle Scholar
  27. 27.
    Mohammed N, Kant P, Abid F, Rotimi O, Prasad P, Hamlin JP, et al. High definition white light endoscopy (Hdwle) versus high definition with chromoendoscopy (Hdce) in the detection of dysplasia in long standing ulcerative colitis: a randomized controlled trial. Gastrointest Endosc. 2015;81(5):AB148.CrossRefGoogle Scholar
  28. 28.
    Dekker E, van den Broek FJ, Reitsma JB, Hardwick JC, Offerhaus GJ, van Deventer SJ, et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy. 2007;39:216–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Ignjatovic A, East JE, Subramanian V, Suzuki N, Guenther T, Palmer N, et al. Narrow band imaging for detection of dysplasia in colitis: a randomized controlled trial. Am J Gastroenterol. 2012;107:885–90.CrossRefPubMedGoogle Scholar
  30. 30.
    Van den Broek FJC, Fockens P, van Eeden S, Reitsma JB, Hardwick JCH, Stokkers PCF, et al. Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomised comparison of high-resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow-band imaging for classification of lesions. Gut. 2008;57:1083–9.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Misawa M, Kudo S-E, Mori Y, Nakamura H, Kataoka S, Maeda Y, et al. Characterization of colorectal lesions using a computer-aided diagnostic system for narrow-band imaging endocytoscopy. Gastroenterology. 2016;150:1531–1532.e3.CrossRefPubMedGoogle Scholar
  32. 32.
    Kiesslich R, Fritsch J, Holtmann M, Koehler HH, Stolte M, Kanzler S, et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology. 2003;124:880–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Kiesslich R, Goetz M, Lammersdorf K, Schneider C, Burg J, Stolte M, et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. 2007;132:874–82.CrossRefPubMedGoogle Scholar
  34. 34.
    Matsumoto T, Nakamura S, Jo Y, Yao T, Iida M. Chromoscopy might improve diagnostic accuracy in cancer surveillance for ulcerative colitis. Am J Gastroenterol. 2003;98:1827–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Hlavaty T, Huorka M, Koller T, Zita P, Kresanova E, Rychly B, et al. Colorectal cancer screening in patients with ulcerative and Crohn’s colitis with use of colonoscopy, chromoendoscopy and confocal endomicroscopy. Eur J Gastroenterol Hepatol. 2011;23:680–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Günther U, Kusch D, Heller F, Bürgel N, Leonhardt S, Daum S, et al. Surveillance colonoscopy in patients with inflammatory bowel disease: comparison of random biopsy vs. targeted biopsy protocols. Int J Color Dis. 2011;26:667–72.CrossRefGoogle Scholar
  37. 37.
    Chiorean MV, Helper DJ, Saxena R, Cummings OW, Tabbey R, Johnson CS. Targeted biopsies using chromoendoscopy can replace random biopsies in patients with IBD at high risk for colorectal neoplasia. Gastroenterology. 2012;142(Suppl 1):S339.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkUSA

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