Diagnosis and Management of Colorectal Neoplasia in Patients with Inflammatory Bowel Disease

Chapter

Abstract

Colorectal cancer (CRC) is a known complication of longstanding and extensive ulcerative colitis (UC) and Crohn’s colitis. The risk of developing CRC in Crohn’s colitis and UC appears to be similar. Several factors are known to confer an increased risk of developing CRC. These include duration, extent and severity of disease, family history of CRC, age, gender, endoscopic features, and a concomitant diagnosis of primary sclerosing cholangitis (PSC). Enrollment in an endoscopic surveillance program has been advocated by the American Gastroenterology Association, the British Society of Gastroenterology, the American College of Gastroenterology, and the Crohn’s and Colitis Foundation of America. The goal of colonoscopic surveillance is to minimize the morbidity and mortality from CRC while identifying those patients who require colectomy. While there is some variation in the specific recommendations, all patients with inflammatory bowel disease (IBD) should undergo a screening colonoscopy 8–10 years after disease onset. With the exception of patients with isolated small bowel Crohn’s and distal ulcerative proctosigmoiditis, subsequent surveillance endoscopies should be performed every 1–3 years depending on risk factors. Adequate surveillance to detect dysplasia involves obtaining a total of 33 biopsies in patients with pan colonic involvement. Chromoendoscopy is a new technique proven to increase the detection of dysplasia. Raised dysplastic lesions may be managed with endoscopic resection if the entire lesion is removed. High grade dysplasia, multifocal low grade dysplasia, and carcinoma are indications for colectomy.

Keywords

Colorectal cancer Primary sclerosing cholangitis Endoscopic surveillance Dysplasia High grade dysplasia Low grade dysplasia Dysplasia associated lesion or mass Chromoendoscopy Colectomy Chemoprevention 

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Section of Gastroenterology, Boston Medical CenterBoston University School of MedicineBostonUSA

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