Non-Polypoid Colorectal Neoplasms in Ulcerative Colitis

The incidence of colorectal cancer associated with ulcerative colitis (UC) increases with time. It is imperative to identify dysplasia-associated lesions or masses (DALM) and non-polypoid colorectal neoplasms (NP-CRN) to reduce the morbidity and mortality from colorectal cancer associated with UC. Recent findings suggest most dysplastic lesions in UC can be considered as visible under careful endoscopic observation. To find NP-CRN in UC, the careful examination of well-prepared mucosa and noting subtle differences is necessary. Magnifying chromoendoscopy, therefore, can be useful to endoscopically diagnose these subtle findings. The authors believe that targeted biopsies during chromoendoscopy will increasingly be used and replace random biopsies in the future.

The increased risk for developing colorectal cancer (CRC) for patients with long-standing ulcerative colitis (UC) is well recognized. To prevent the morbidity and mortality from CRC, it is essential to diagnose the lesions at the premalignant or early malignant stages. The findings of dysplasia and dysplasia-associated lesions or masses (DALM) are important in patients with UC because their findings often signify the presence of cancer.

Recent studies have shown that the detection of non-polypoid colorectal neoplasms (NP-CRN) is an integral component in the early detection of UC-associated CRC. Unlike DALM, which is readily visible, NP-CRN is often subtle and can be difficult to detect. NP-CRN in UC often presents as redness or a granular patch of mucosa, which may not be readily distinguishable from the surrounding inflamed mucosa. Magnifying chromoendoscopy can be useful to enhance our ability to detect NP-CRN and enable targeted biopsies and increase the detection rate of dysplasia/cancer. Within this perspective, the authors summarize the endoscopic diagnosis, prevalence, characteristics, and the recent concepts for management of NP-CRN in UC.

Prevalence of non-polypoid colorectal neoplasms in ulcerative colitis

Colorectal Cancer Risk in Patients with Ulcerative Colitis

The risk for developing CRC increases with early age at diagnosis of UC, longer duration of symptoms, and severity of inflammation and dysplasia. In addition, postinflammatory polyps and strictures are features of previous severe inflammation and signify an increased risk for colorectal cancer. A meta-analysis that reviewed 116 studies of CRC in UC from around the world found the prevalence of CRC in subjects with UC to be 3.7% overall and 5.4% for those with pancolitis. These incidence rates corresponded to cumulative probabilities of 2% by 10 years, 8% by 20 years, and 18% by 30 years. In a study sponsored by the Japanese Ministry of Health, Labor, and Welfare the prevalence is similar. The factors that increase the risk for developing CRC in the setting of UC are listed in Box 1 .

Box 1

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