Colonic Dysplasia/Cancer Surveillance
Objective: Early detection of colon cancer/dysplasia |
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Patient population: Patients with a known diagnosis of IBD whose disease is in endoscopic remission. Active inflammation precludes a detailed assessment of colonic dysplasia. |
Highlight BoxThe applicability of some suggested recommendations in these guidelines may be impacted by the IBD practitioners’ access to recommended resources (colonic dye spray / virtual chromoendoscopy). |
Introduction
This care protocol aims to provide IBD providers guidelines for colonic dysplasia/cancer surveillance based on patients’ risk.
IBD Provider:
Patient Populations |
Recommendation |
Ulcerative colitis extending beyond the rectum or Crohn’s colitis involving 1/3 or more of the colon, has had disease for at least 8 years |
Surveillance colonoscopy recommended, frequency according to risk (see Figure 1) (PACE QPI 11) |
Ulcerative colitis or Crohn’s colitis (of any duration) and has coexisting primary sclerosing cholangitis (PSC) |
Annual surveillance colonoscopy (PACE QPI 10) |
Ulcerative colitis or Crohn’s colitis has confirmed dysplasia in flat mucosa |
Early repeat colonoscopic surveillance using pancolonic dye spray or virtual chromoendoscopy (interval depending on dysplasia risk). Consider surgical referral in very high-risk cases (i.e. high-grade dysplasia or multi-focal dysplasia) (PACE QPI 19) |
Ulcerative colitis or Crohn’s colitis has confirmed visible dysplasia |
Continued endoscopic surveillance if confirmed complete endoscopic resection and no invasive cancer on histology (interval depending on dysplasia risk); otherwise, surgical referral |
Total proctocolectomy with an ileal pouch-anal anastomosis (IPAA) |
Surveillance endoscopy according to risk (see Figure 2) |
IBD with a subtotal colectomy |
Consider surgical referral for a completion proctectomy as an alternative to ongoing endoscopic dysplasia surveillance; otherwise, endoscopic surveillance every 1- 5 years, depending on risk factors for colorectal cancer (See Figure 1). (PACE QPI 8) |
Figure 1: Surveillance recommendations for colonoscopy