Advances in the Diagnosis and Management of Colonic Dysplasia in Patients With Inflammatory Bowel Disease Shirley Cohen-Mekelburg , MD, Yecheskel Schneider, MD, Stephanie Gold, MD, Ellen Scherl, MD, and Adam Steinlauf, MD
Dr Cohen-Mekelburg and Dr Schneider are gastroenterology fellows, Dr Gold is an internal medicine resident, Dr Scherl is a clinical professor and attending physician, and Dr Steinlauf is an assistant professor and attending physician at NewYork-Presbyterian/ Weill Cornell Medical Center in New York, New York.
Abstract: The prevalence of colorectal cancer (CRC) in inflammatory bowel disease (IBD) is estimated at 3.7%. Risk factors for CRC include more severe disease (as reflected by the extent of disease and the duration of poorly controlled disease), family history of CRC, pseudopolyps, primary sclerosing cholangitis, and male sex. In addition, both early and late onset of IBD have been shown to be risk factors in different studies. Most societal guidelines recommend initiation of surveillance colonoscopy at 8 to 10 years after IBD symptom onset, followed by subsequent surveillance in
Address correspondence to: Dr Shirley Cohen-Mekelburg 1305 York Avenue, 4th Floor New York, NY 10021 Tel: 646-962-4800 Fax: 646-962-0399 E-mail: [email protected]
1- to 2-year intervals. A recent paradigm shift has led to a focus on targeted biopsies using high-definition colonoscopy or chromoendoscopy rather than traditional white-light endoscopy, as most dysplasia has proven to be visible with these advances in technology. With this shift, endoscopic resection of focal dysplasia, rather than early recommendation for colectomy, has become commonplace. Future studies should focus on newer methods of dysplasia detection, along with comparative effectiveness trials, to determine the optimal approach. Individual risk stratification may also prove beneficial in determining optimal surveillance strategies and intervals.
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Keywords Surveillance, colorectal cancer, carcinoma, colonoscopy, ulcerative colitis, Crohn’s disease
atients with inflammatory bowel disease (IBD) carry a higher risk of developing colorectal cancer (CRC) than the general population.1,2 The risk is similar in Crohn’s disease and ulcerative colitis, although CRC seems to present at a later stage in Crohn’s disease compared to ulcerative colitis.3-5 The prevalence of CRC in IBD is estimated at 3.7% according to an early meta-analysis.1 Incidence rates of 0.2% to 2.0% at 10 years of disease, 1.4% to 8.0% at 20 years, and 3.1% to 18.0% at 30 years have been reported in the literature.1,6 A more recent prospective study using the CESAME (Cancers et Surrisque Associé aux Maladies Inflammatoires Intestinales en France) cohort confirms the high risk of CRC in IBD with a standardized incidence ratio of 2.2 (95% CI, 1.5-3.0; P
Dr Cohen-Mekelburg and Dr Schneider are gastroenterology fellows, Dr Gold is an internal medicine resident, Dr Scherl is a clinical professor and attending physician, and Dr Steinlauf is an assistant professor and attending physician at NewYork-Presbyterian/ Weill Cornell Medical Center in New York, New York.
Abstract: The prevalence of colorectal cancer (CRC) in inflammatory bowel disease (IBD) is estimated at 3.7%. Risk factors for CRC include more severe disease (as reflected by the extent of disease and the duration of poorly controlled disease), family history of CRC, pseudopolyps, primary sclerosing cholangitis, and male sex. In addition, both early and late onset of IBD have been shown to be risk factors in different studies. Most societal guidelines recommend initiation of surveillance colonoscopy at 8 to 10 years after IBD symptom onset, followed by subsequent surveillance in
Address correspondence to: Dr Shirley Cohen-Mekelburg 1305 York Avenue, 4th Floor New York, NY 10021 Tel: 646-962-4800 Fax: 646-962-0399 E-mail: [email protected]
1- to 2-year intervals. A recent paradigm shift has led to a focus on targeted biopsies using high-definition colonoscopy or chromoendoscopy rather than traditional white-light endoscopy, as most dysplasia has proven to be visible with these advances in technology. With this shift, endoscopic resection of focal dysplasia, rather than early recommendation for colectomy, has become commonplace. Future studies should focus on newer methods of dysplasia detection, along with comparative effectiveness trials, to determine the optimal approach. Individual risk stratification may also prove beneficial in determining optimal surveillance strategies and intervals.
P
Keywords Surveillance, colorectal cancer, carcinoma, colonoscopy, ulcerative colitis, Crohn’s disease
atients with inflammatory bowel disease (IBD) carry a higher risk of developing colorectal cancer (CRC) than the general population.1,2 The risk is similar in Crohn’s disease and ulcerative colitis, although CRC seems to present at a later stage in Crohn’s disease compared to ulcerative colitis.3-5 The prevalence of CRC in IBD is estimated at 3.7% according to an early meta-analysis.1 Incidence rates of 0.2% to 2.0% at 10 years of disease, 1.4% to 8.0% at 20 years, and 3.1% to 18.0% at 30 years have been reported in the literature.1,6 A more recent prospective study using the CESAME (Cancers et Surrisque Associé aux Maladies Inflammatoires Intestinales en France) cohort confirms the high risk of CRC in IBD with a standardized incidence ratio of 2.2 (95% CI, 1.5-3.0; P
