Getting a Low Grade for Missing High-Grade Dysplasia and Colorectal Cancer in IBD

Excerpt

Inflammatory bowel disease (IBD) is associated with an increased risk of developing colorectal cancer (CRC) associated with the duration and extent of the disease [1]. Unlike sporadic CRC, CRC in IBD patients is often difficult to detect, due to the presence of ill-defined margins and often atypical gross and endoscopic appearances [2]. CRC in IBD patients is associated not only with high-grade dysplasia (HGD) but also with low-grade dysplasia (LGD), either of which may be multifocal, polypoid, flat, or invisible. Accordingly, surveillance at 2-year intervals is recommended starting 8–10 years after diagnosis, with colectomy recommended for colonoscopic identification of high-risk lesions such as multifocal or polyploid LGD, HGD, and CRC [2]. Over the last decade, as newer endoscopic techniques such as chromo-, narrow-band, and high-definition endoscopy have matured, the management of IBD-associated mucosal abnormalities, particularly LGD, has shifted toward decreasing rates of colectomy in favor of endoscopic management [3]. This trend was generally endorsed in the Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendation (SCENIC) guidelines for the management of dysplasia and carcinoma in IBD [4]. An important consideration as these newer strategies become more widespread is the rate of undetected advanced lesions (HGD and invasive carcinoma) in patients undergoing endoscopic surveillance, for which remarkably few data are available. …