Surveillance for dysplasia in inflammatory bowel disease

Patients with long-standing ulcerative colitis and Crohn’s disease with colonic involvement are at increased risk for the development of colorectal cancer compared with the general population. To minimize that risk, gastroenterologists, pathologists, and patients work together within a system of surveillance in which patients with one-third or more of their colon involved undergo periodic colonoscopies. The key feature of surveillance is timely identification and subsequent removal of all dysplasia (flat and raised polyps) and timely colectomy for patients in whom clearance of dysplasia cannot be safely achieved - polyps too large or numerous to remove or occult dysplasia present. Adjunctive techniques such as spray-dye chromoendoscopy are being developed to improve lesion identification and maximize the potential for colonoscopy while minimizing unnecessary colectomies. While the success of the surveillance system cannot be certainly quantified, colorectal cancer morbidity and mortality in the inflammatory bowel disease population appears to be decreasing commensurate with its widespread adoption.