Novel Diagnostic and Therapeutic Techniques for Surveillance of Dysplasia in Patients with Inflammatory Bowel Disease

Abstract

The risk for developing dysplasia and colorectal cancer in patients with longstanding inflammatory bowel disease (IBD) involving the colon is well documented. Random biopsies during white-light, standard-definition colonoscopy (33 to 50 biopsies) with or without dye spraying chromoendoscopy has been the recommended strategy in North America to detect dysplastic lesions in IBD. However, there are several limitations to this approach including poor physician adherence, poor sensitivity, increased procedure time and considerable cost. The new generation of high-definition endoscopes with electronic filter technology provide an opportunity to visualize colonic mucosal and vascular patterns in minute detail, and to identify subtle flat, multifocal, polypoid and pseudopolypoid neoplastic and non-neoplastic lesions. The application of these new technologies in IBD is slowly being adopted in clinical practice. In addition, the advent of confocal laser endomicroscopy provides an opportunity to explore real-time histology, thus redefining the understanding and characterization of the lesions in IBD. There is emerging evidence that serrated adenomas are also associated with longstanding IBD colitis and may be recognized as another important contributing factor to colorectal cancer development. The circumscribed neoplastic lesions can be treated using endoscopic therapeutic management such as mucosal resection or, especially, endoscopic submucosal dissection. This may replace panproctocolectomy in selected patients. The authors review the potential of these techniques to transform endoscopic diagnosis and therapeutic management of dysplasia in IBD.

Targeted Biopsies Identify Larger Proportions of Patients With Colonic Neoplasia Undergoing High-Definition Colonoscopy, Dye Chromoendoscopy, or Electronic Virtual Chromoendoscopy

“…However, this is time consuming and often is not followed in clinical practice. 21 In fact, in the current audit, we found that our IBD gastroenterologists took a widely variable number of biopsy specimens in the surveillance group with random biopsies, with 23 median biopsy specimens and a range of 4 to 50 biopsy specimens. This may explain why random biopsies perform less well in the detection of neoplastic lesions compared with targeted biopsies.…”

“…using WLE, HD, VCE, and DCE. 21,25 The details of the techniques and equipment used are shown in Table 2: WLE were standard definition, all others were HD (including HD with white light). The HD endoscopes with electronic filter technology (iSCAN, Tokyo, Japan) may improve the detection and characterization of mucosal and vascular patterns of neoplastic lesions.…”

“…[18][19][20] In addition, there are now a number of strategies that currently are evolving, including targeted biopsies using DCE and virtual electronic chromoendoscopy (VCE). 21 Therefore, practice variation is increasing.…”

Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

“…The management of circum-DOI: 10.1159/000494409 scribed dysplastic lesions within colitic mucosa should be determined by endoscopic resectability. If the lesion is well circumscribed and can be fully removed, endoscopic resection may be an effective treatment [6][7][8]. Endoscopic treatment preserves the rectum and colon, which results in a better quality of life compared to that after surgery.…”

DNA Methylation and Mutation of Small Colonic Neoplasms in Ulcerative Colitis and Crohnʼs Colitis

“…(1–4) CRC risk increases with IBD duration, extent of colonic involvement, prior neoplasia, family history of CRC, and primary sclerosing cholangitis (PSC). (2, 5–7) Accordingly, patients with colonic IBD and these risks are advised to undergo surveillance every 1–3 years(8) by colonoscopy.…”