Toward a Consensus on Endoscopic Surveillance of Patients with Colonic Inflammatory Bowel Disease

Surveillance colonoscopy in patients with inflammatory bowel disease (IBD) with colonic involvement is recommended by multiple national and international gastrointestinal societies. Recommendations differ on the timing of initial screening colonoscopy, recommended surveillance intervals, optimal technique for dysplasia detection, and management of endoscopically visible and nonvisible dysplasia. This article reviews current society guidelines, highlighting similarities and differences, in an attempt to summarize areas of consensus on surveillance protocols in IBD, while drawing attention to controversial areas in need of further research.

Key points

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All patients with ulcerative colitis (UC) and Crohn’s colitis should be offered a screening colonoscopy 8 to 10 years after onset of disease symptoms to restage extent of disease and evaluate for endoscopic features that confer an increased risk for inflammatory bowel disease–associated colorectal neoplasia (IBD-CRN).
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Surveillance colonoscopy should be offered to UC patients with left-sided or extensive colitis (thus excluding patients with isolated proctitis), and for patients with Crohn’s colitis involving more than 1 segment of the colon or at least one-third of the colon.
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Patients with the highest risk of IBD-CRN should undergo annual surveillance. Lower-risk patients can undergo surveillance at less frequent intervals, every 2 to 5 years.
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European and Australian guidelines agree that dye-based chromoendoscopy with targeted biopsies maximizes detection of colorectal neoplasia during surveillance colonoscopy, and is the surveillance method of choice. Most United States guidelines endorse chromoendoscopy with targeted biopsy as an option for surveillance.
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Endoscopically visible lesions that are well circumscribed and amenable to endoscopic resection with no evidence of dysplasia in the surrounding flat mucosa or elsewhere in the colon are appropriate for continued colonoscopic surveillance.