Clin Endosc.  2012 Sep;45(3):274-277.

Colonoscopic Cancer Surveillance in Inflammatory Bowel Disease: What's New Beyond Random Biopsy?

Affiliations
  • 1Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK. jameseast6@yahoo.com

Abstract

Colonoscopy based colitis surveillance is widely accepted to try to prevent development of and ensure early detection of colitis-associated colorectal cancer. Traditionally this has been performed with quadrantic random biopsies throughout the colon. Chromoendoscopy "dye-spray" with targeted biopsies only has been shown to increase dysplasia detection 4 to 5 fold on a per lesion basis. It has therefore been suggested that random biopsies should be abandoned as they do not increase dysplasia detection nor change patient clinical course. Recent British guidelines for colitis surveillance have strongly endorsed chromoendoscopy. This short review summarizes current international guidelines and looks at how to optimize white light colonoscopy in colitis considering: bowel preparation, withdrawal time, high definition, and structure enhancement. Data for advanced imaging techniques are reviewed including positive evidence in favor of chromoendoscopy, and limited data suggesting autofluoresence imaging may be promising. Narrow band imaging does not increase dysplasia detection in colitis. Confocal endomicroscopy might potentially reduce biopsies beyond that of chromoendoscopy but does not offer a clear detection advantage. Pan-colonic chromoendoscopy with targeted biopsies increases dysplasia detection and is the standard of care in the United Kingdom. It is likely that the use of chromoendoscopy for colitis surveillance will become widely accepted internationally.

Keyword

Ulcerative colitis; Crohn disease; Colonoscopy; Dysplasia; Surveillance

MeSH Terms

Biopsy
Colitis
Colitis, Ulcerative
Colon
Colonoscopy
Colorectal Neoplasms
Crohn Disease
Dietary Sucrose
Great Britain
Humans
Imidazoles
Light
Narrow Band Imaging
Nitro Compounds
Standard of Care
Dietary Sucrose
Imidazoles
Nitro Compounds

Reference

1. East JE, Saunders BP, Burling D, Boone D, Halligan S, Taylor SA. Surface visualization at CT colonography simulated colonoscopy: effect of varying field of view and retrograde view. Am J Gastroenterol. 2007; 102:2529–2535. PMID: 17640320.
Article
2. van den Broek FJ, Stokkers PC, Reitsma JB, et al. Random biopsies taken during colonoscopic surveillance of patients with longstanding ulcerative colitis: low yield and absence of clinical consequences. Am J Gastroenterol. Epub 2011 Mar 22. DOI:http://dx.doi.org/10.1038/ajg.2011.93.
Article
3. Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010; 59:666–689. PMID: 20427401.
Article
4. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001; 48:526–535. PMID: 11247898.
Article
5. Elsadani NN, East JE, Walters JR. New 2010 British Society of Gastroenterology colitis surveillance guidelines: costs and surveillance intervals. Gut. 2011; 60:282–283. PMID: 20966028.
Article
6. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006; 355:2533–2541. PMID: 17167136.
Article
7. Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005; 61:378–384. PMID: 15758907.
Article
8. Toruner M, Harewood GC, Loftus EV Jr, et al. Endoscopic factors in the diagnosis of colorectal dysplasia in chronic inflammatory bowel disease. Inflamm Bowel Dis. 2005; 11:428–434. PMID: 15867581.
Article
9. Hurlstone DP, Sanders DS, Lobo AJ, McAlindon ME, Cross SS. Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation. Endoscopy. 2005; 37:1186–1192. PMID: 16329015.
Article
10. Kiesslich R, Fritsch J, Holtmann M, et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology. 2003; 124:880–888. PMID: 12671882.
Article
11. Kiesslich R, Goetz M, Lammersdorf K, et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. 2007; 132:874–882. PMID: 17383417.
Article
12. Marion JF, Waye JD, Present DH, 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; 103:2342–2349. PMID: 18844620.
Article
13. 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; 53:256–260. PMID: 14724160.
Article
14. Kiesslich R, Neurath MF. Surveillance colonoscopy in ulcerative colitis: magnifying chromoendoscopy in the spotlight. Gut. 2004; 53:165–167. PMID: 14724144.
Article
15. Dekker E, van den, Reitsma JB, et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy. 2007; 39:216–221. PMID: 17385106.
Article
16. van den Broek FJ, Fockens P, van Eeden S, et al. Narrow-band imaging versus high-definition endoscopy for the diagnosis of neoplasia in ulcerative colitis. Endoscopy. 2011; 43:108–115. PMID: 21165822.
Article
17. Ignjatovic A, East JE, Subramanian V, et al. Narrow band imaging for detection of dysplasia in colitis: a randomized controlled trial. Am J Gastroenterol. Epub 2012 May 22. DOI:http://dx.doi.org/10.1038/ajg.2012.67.
Article
18. van den Broek FJ, Fockens P, van Eeden S, 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; 57:1083–1089. PMID: 18367559.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr