Learning to Detect Flat Neoplastic Lesions in Inflammatory Bowel Disease

It has become increasingly evident that American gastroenterologists have become overly dependent on random biopsies whether in the esophagus, stomach, or colon. Times have changed. Current high-resolution endoscopes combined with large high-definition monitors can now help tremendously in locating and characterizing flat lesions throughout the GI tract, which are premalignant or foci of early neoplasia. Chromoendoscopy and new versions of digital chromoendoscopy can be additionally helpful. Nowhere is this more important than in colonoscopy surveillance of patients with inflammatory bowel disease, who have a significantly increased risk of developing colorectal cancer. For years, foci of early neoplasia have been considered too occult to detect in patients with colitis. Huge numbers of random biopsies have been recommended to decrease sampling error in an effort to find dysplasia on pathology specimens. This laborious and expensive methodology has had a low yield and little benefit in community practice and has been abandoned by many.

Dr Roy Soetikno and Dr Tonya Kaltenbach are the editors for this issue of Gastrointestinal Endoscopy Clinics of North America , which is devoted to the improved detection and management of early neoplasia in inflammatory bowel disease. An important aspect of Dr Soetikno’s outstanding career has been the bridging of endoscopic methods between Japan and the United States. Endoscopists in Japan have a better record of detecting subtle flat GI lesions. From the earliest days of endoscopy, it is fair to say that Japanese endoscopists have emphasized visual identification, analysis, and photo documentation of small GI lesions. The colon has been no exception. Dr Soetikno has incorporated these techniques, which have become increasingly feasible with steady improvement in modern digital endoscopes. Identifying small flat premalignant lesions and early cancers in patients with colitis can be lifesaving. Dr Soetikno and Dr Kaltenbach have edited an extraordinary issue of the Gastrointestinal Endoscopy Clinics of North America devoted to teaching and promulgating these methods, including an extensive photo atlas, which should be an invaluable resource for all academic specialists and practicing gastroenterologists.

A generous philanthropic grant has made this issue available free online. Don’t fail to take advantage of the opportunity to read and share the entire issue, which should change our approach to colonoscopy surveillance in inflammatory bowel disease.

Only gold members can continue reading. Log In or Register to continue