Chronic Inflammatory Bowel Disease in Remission: Mucosal Neoplasias

  • Naohisa YahagiEmail author
  • Tadateru Maehata
  • Atsushi Nakayama


Colonoscopic surveillance for risk of colorectal cancer (CRC) associated with inflammatory bowel disease (IBD) is recommended annually beginning at 8 years disease duration in ulcerative pancolitis and Crohn’s colitis. Family history of sporadic CRC raises the risk of CRC by twofold, and association with primary sclerosing cholangitis by fourfold. Optimized conditions for endoscopy, random and targeted biopsy requirements, and patient information and compliance are essential for success of the surveillance program, as well as experienced endoscopic detection and classification of neoplastic lesions as (1) sporadic lesions (in uninvolved colon) and in involved bowel, (2) polypoid dysplastic lesions, and (3) non-polypoid dysplastic lesions. Endoscopic en bloc resection (with free margins) is recommended for all resectable lesions without invisible dysplasia, whereas sphincter-preserving colectomy is recommended for endoscopically unresectable non-polypoid lesions and invisible lesions detected by random biopsy.


Ulcerative colitis Crohn’s colitis Colonoscopic surveillance Colorectal cancer (CRC) risk Dysplasia, polypoid and non-polypoid Invisible dysplasia Targeted biopsy vs. random biopsy Microvessel pattern Endoscopic resection, indications Colectomy, indications 



The contribution of a case by Dr. Gerhard Kleber of Aalen, Germany, and the evaluation of histology by Dr. Daniel Neureiter of Salzburg, Austria, are gratefully acknowledged.


  1. 1.
    Eaden JA, et al. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48:526–35.CrossRefGoogle Scholar
  2. 2.
    Jess T, et al. Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol. 2005;100:2724–9.CrossRefGoogle Scholar
  3. 3.
    Ekbom A, et al. Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet. 1990;336:357–9.CrossRefGoogle Scholar
  4. 4.
    Farraye FA, et al. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:746–74.CrossRefGoogle Scholar
  5. 5.
    Bernstein CN, et al. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer. 2001;91:854–62.CrossRefGoogle Scholar
  6. 6.
    Rutter MD, et al. Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology. 2006;130:1030–8.CrossRefGoogle Scholar
  7. 7.
    Lutgens MW, et al. High frequency of early colorectal cancer in inflammatory bowel disease. Gut. 2008;57:1246–51.CrossRefGoogle Scholar
  8. 8.
    Beaugerie L, et al. Cancers complicating inflammatory bowel disease. N Engl J Med. 2015;372:1441–52.Google Scholar
  9. 9.
    Soetikno RM, et al. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc. 2002;56:48–54.CrossRefGoogle Scholar
  10. 10.
    Broome U, et al. Primary sclerosing cholangitis and ulcerative colitis: evidence for increased neoplastic potential. Hepatology. 1995;22:1404–8.PubMedGoogle Scholar
  11. 11.
    Lichtiger S, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994;330:1841–5.CrossRefGoogle Scholar
  12. 12.
    Laine L, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc. 2015;81:489–501.CrossRefGoogle Scholar
  13. 13.
    Magro F, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017;11:649–70.CrossRefGoogle Scholar
  14. 14.
    Watanabe T, et al. Comparison of targeted vs random biopsies for surveillance of ulcerative colitis-associated colorectal cancer. Gastroenterology. 2016;151:1122–30.CrossRefGoogle Scholar
  15. 15.
    Kiesslich R, et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology. 2003;124:880–8.CrossRefGoogle Scholar
  16. 16.
    Marion JF, 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.CrossRefGoogle Scholar
  17. 17.
    Bisschops R, et al. Chromoendoscopy versus narrow band imaging in UC: a prospective randomised controlled trial. Gut. 2018;67:1087–94.CrossRefGoogle Scholar
  18. 18.
    Farraye FA, et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:738–45.CrossRefGoogle Scholar
  19. 19.
    Gumaste V, et al. Benign and malignant colorectal strictures in ulcerative colitis. Gut. 1992;33:938–41.CrossRefGoogle Scholar
  20. 20.
    Soetikno R, et al. Paradigm shift in the surveillance and management of dysplasia in inflammatory bowel disease (West). Dig Endosc. 2016;28:266–73.CrossRefGoogle Scholar
  21. 21.
    Chiu K, et al. DALM, rest in peace: a pathologist’s perspective on dysplasia in inflammatory bowel disease in the post-DALM era. Mod Pathol. 2018;31:1180–90.CrossRefGoogle Scholar
  22. 22.
    Sugimoto S, et al. Endoscopic morphologic features of ulcerative colitis-associated dysplasia classified according to the SCENIC consensus statement. Gastrointest Endosc. 2017;85:639–46.CrossRefGoogle Scholar
  23. 23.
    Iacucci M, et al. A multimodal (FACILE) classification for optical diagnosis of inflammatory bowel disease associated neoplasia. Endosc 2019;51:133–41.Google Scholar
  24. 24.
    Rubio CA, et al. Villous and serrated adenomatous growth bordering carcinomas in inflammatory bowel disease. Anticancer Res. 2000;20:4761–4.PubMedGoogle Scholar
  25. 25.
    Lim CH, et al. Ten year follow up of ulcerative colitis patients with and without low grade dysplasia. Gut. 2003;52:1127–32.CrossRefGoogle Scholar
  26. 26.
    Odze RD. Adenomas and adenoma-like DALMs in chronic ulcerative colitis: a clinical, pathological, and molecular review. Am J Gastroenterol. 1999;94:1746–50.CrossRefGoogle Scholar
  27. 27.
    Odze RD, et al. Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis. Clin Gastroenterol Hepatol. 2004;2:534–41.CrossRefGoogle Scholar
  28. 28.
    Ullman TA, et al. The fate of low grade dysplasia in ulcerative colitis. Am J Gastroenterol. 2002;97:922–7.CrossRefGoogle Scholar
  29. 29.
    Kinoshita S, et al. The role of colorectal endoscopic submucosal dissection in patients with ulcerative colitis. Gastrointest Endosc. 2018;87:1079–84.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  • Naohisa Yahagi
    • 1
    Email author
  • Tadateru Maehata
    • 1
  • Atsushi Nakayama
    • 1
  1. 1.Division of Research and Development for Minimally Invasive TreatmentCancer Center, Keio University School of MedicineShinjuku-kuJapan

Personalised recommendations