Review article: The relevance of surveillance endoscopy in long-lasting inflammatory bowel disease.
BACKGROUND
Development of colitis-associated colorectal cancer is an important clinical problem in patients with colonic inflammatory bowel disease (IBD). British and American guidelines recommend to start surveillance after a disease duration of 8-10 or 15-20 years for patients with extensive or left-sided colitis, respectively.


OBJECTIVE
To assess the evidence level of current surveillance strategies.


METHODS
A PubMed-based literature search using the search terms inflammatory bowel disease, ulcerative colitis, Crohn's disease, dysplasia, colorectal cancer and surveillance was performed.


RESULTS
Low-grade and high-grade dysplastic lesions progress to cancer in a high percentage of patients. Furthermore, concurrent cancer is found in approximately one-third of the patients with colonic dysplasia. Low-level evidence showing reduced colorectal cancer-related mortality in patients who were undergoing surveillance is available. Patients with concomitant primary sclerosing cholangitis form a subgroup of IBD patients with an even higher risk of colorectal neoplasia.


CONCLUSIONS
Colonic surveillance prolongs life expectancy of patients with long-lasting IBD.
Vleggaar
F P
FP
Department of Gastroenterology, University Medical Center Utrecht, The Netherlands. f.vleggaar@umcutrecht.nl
Lutgens
M W M D
MW
Claessen
M M H
MM
D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012307:Risk Factors