AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review

Murthy, Sanjay K.; Feuerstein, Joseph D.; Nguyen, Geoffrey C.; Velayos, Fernando

doi:10.1053/j.gastro.2021.05.063

Cited by 143 publications

(181 citation statements)

References 112 publications

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“…The currently available international guidelines instruct on the use of virtual chromoendoscopy (VCE) as a suitable alternative, due to insufficient evidence to recommend it as preferred method ( 9 , 25 ). Initial studies for dysplasia detection in IBD have explored VCE.…”

Section: Virtual Chromoendoscopymentioning

confidence: 99%

Endoscopic Surveillance in Inflammatory Bowel Diseases: Selecting a Suitable Technology

et al. 2022

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In the treat-to-target era, endoscopy has become the backbone of the assessment of remission, defined as mucosal healing, in inflammatory bowel disease (IBD) patients. Current recommendations indicate that endoscopic procedures should be performed with high-definition white-light endoscopy (HD-WLE), as it guarantees the best possible visualization of the mucosa. With respect to endoscopic surveillance, the preventive strategy for dysplasia and colorectal cancer (CRC) in long-standing IBD, is the use of dye-chromoendoscopy (DCE), which enhances the mucosal pattern of the colonic walls. DCE has been established as the gold standard for dysplasia detection and is at present incorporated in all international guidelines. Over the past years, novel technologies, such as high-definition endoscopic imaging, and optical and digital enhancement tools have revolutionized the quality and level of fine details of vascular and mucosal patterns. These endoscopic images have the ambition to reflect histological changes for suspected neoplastic lesions and inflammation or healing and are emerging as potential alternatives to DCE. Indeed, the comparison of DCE with high-definition imaging is an open issue that deserves further investigation. We aimed to examine and summarize the technical aspects and the current evidence on endoscopic technologies with a specific focus on the surveillance in IBD patients.

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Section: Virtual Chromoendoscopymentioning

confidence: 99%

Endoscopic Surveillance in Inflammatory Bowel Diseases: Selecting a Suitable Technology

et al. 2022

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“…As endoscopic technology continues to evolve, societal guidelines are updated to represent the latest tools and data to help guide surveillance strategies for patients with UC. Specifically, the SCENIC (Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients International Consensus) guidelines were established in 2015 to address surveillance and management strategies of dysplasia in inflammatory bowel disease (IBD) ( Table 1 ) [ 9 , 10 , 27 , 28 ].…”

Section: Surveillance Modalitiesmentioning

confidence: 99%

“…In the case of UC-associated neoplasia, they recommend that the slides be reviewed by an experienced GI pathologist and neoplastic findings be reviewed by a second experienced GI pathologist; this is also suggested by the European Crohn’s and Colitis Organization (ECCO) [ 9 , 27 ]. The more recent American Gastroenterology Association (AGA) best practice advice statement, released in 2021, suggests that this period of follow-up surveillance can be 1 to 5 years [ 28 ]. This is dependent on the risk of developing CRC, the burden of inflammation, family history of CRC, history of PSC, the detection of prior dysplasia, and the quality and frequency of previous surveillance colonoscopies.…”

Section: Surveillance Strategiesmentioning

confidence: 99%

“…They suggested that the first surveillance colonoscopy should be performed within 1 year of LGD detection [ 41 ]. The current guidelines differ on the recommended surveillance intervals for colonoscopy, with the current United States guidelines recommending 1–3 or 1–5 years [ 9 , 28 ]. The ECCO consensus statement recommends repeat surveillance based on the risk of developing dysplasia.…”

Section: Surveillance Strategiesmentioning

confidence: 99%

“…Endoscopically visible lesions within an area of colitis should be evaluated for resectablity, with the knowledge that resecting lesions in areas of active inflammation can be more challenging. As per the ASGE guideline and AGA clinical practice update, endoscopically visible lesions that are clearly demarcated without evidence of submucosal invasion should be considered for endoscopic resection [ 12 , 28 ]. When the expertise is available, these lesions should be resected en bloc to confirm complete histologic resection; this may necessitate a referral to centers with advanced polypectomy experience.…”

Section: Management Of Dysplasia and Cancermentioning

confidence: 99%

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Colorectal Dysplasia and Cancer Surveillance in Ulcerative Colitis

et al. 2021

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Ulcerative colitis (UC) is a risk factor for the development of inflammation-associated dysplasia or colitis-associated neoplasia (CAN). This transformation results from chronic inflammation, which induces changes in epithelial proliferation, survival, and migration via the induction of chemokines and cytokines. There are notable differences in genetic mutation profiles between CAN in UC patients and sporadic colorectal cancer in the general population. Colonoscopy is the cornerstone for surveillance and management of dysplasia in these patients. There are several modalities to augment the quality of endoscopy for the better detection of dysplastic or neoplastic lesions, including the use of high-definition white-light exam and image-enhanced colonoscopy, which are described in this review. Clinical practice guidelines regarding surveillance strategies in UC have been put forth by various GI societies, and overall, there is agreement between them except for some differences, which we highlight in this article. These guidelines recommend that endoscopically detected dysplasia, if feasible, should be resected endoscopically. Advanced newer techniques, such as endoscopic mucosal resection and endoscopic submucosal dissection, have been utilized in the treatment of CAN. Surgery has traditionally been the mainstay of treating such advanced lesions, and in cases where endoscopic resection is not feasible, a proctocolectomy, followed by ileal pouch-anal anastomosis, is generally recommended. In this review we summarize the approach to surveillance for cancer and dysplasia in UC. We also highlight management strategies if dysplasia is detected.

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Ulcerative Colitis in Adults

Gros,

Kaplan

2023

JAMA

131

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ImportanceUlcerative colitis (UC) is a chronic inflammatory condition of the colon, with a prevalence exceeding 400 per 100 000 in North America. Individuals with UC have a lower life expectancy and are at increased risk for colectomy and colorectal cancer.ObservationsUC impairs quality of life secondary to inflammation of the colon causing chronic diarrhea and rectal bleeding. Extraintestinal manifestations, such as primary sclerosing cholangitis, occur in approximately 27% of patients with UC. People with UC require monitoring of symptoms and biomarkers of inflammation (eg, fecal calprotectin), and require colonoscopy at 8 years from diagnosis for surveillance of dysplasia. Risk stratification by disease location (eg, Montreal Classification) and disease activity (eg, Mayo Score) can guide management of UC. First-line therapy for induction and maintenance of remission of mild to moderate UC is 5-aminosalicylic acid. Moderate to severe UC may require oral corticosteroids for induction of remission as a bridge to medications that sustain remission (biologic monoclonal antibodies against tumor necrosis factor [eg, infliximab], α4β7 integrins [vedolizumab], and interleukin [IL] 12 and IL-23 [ustekinumab]) and oral small molecules that inhibit janus kinase (eg, tofacitinib) or modulate sphingosine-1-phosphate (ozanimod). Despite advances in medical therapies, the highest response to these treatments ranges from 30% to 60% in clinical trials. Within 5 years of diagnosis, approximately 20% of patients with UC are hospitalized and approximately 7% undergo colectomy. The risk of colorectal cancer after 20 years of disease duration is 4.5%, and people with UC have a 1.7-fold higher risk for colorectal cancer compared with the general population. Life expectancy in people with UC is approximately 80.5 years for females and 76.7 years for males, which is approximately 5 years shorter than people without UC.Conclusions and RelevanceUC affects approximately 400 of every 100 000 people in North America. An effective treatment for mild to moderate UC is 5-aminosalicylic acid, whereas moderate to severe UC can be treated with advanced therapies that target specific inflammation pathways, including monoclonal antibodies to tumor necrosis factor, α4β7 integrins, and IL-12 and IL-23 cytokines, as well as oral small molecule therapies targeting janus kinase or sphingosine-1-phosphate.

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AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review

Cited by 143 publications

References 112 publications

Endoscopic Surveillance in Inflammatory Bowel Diseases: Selecting a Suitable Technology

Endoscopic Surveillance in Inflammatory Bowel Diseases: Selecting a Suitable Technology

Colorectal Dysplasia and Cancer Surveillance in Ulcerative Colitis

Ulcerative Colitis in Adults

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