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New Recommendations for Colorectal Cancer Surveillance in Patients With IBD BETHESDA, Md -- February 16, 2010 -- Certain patients with inflammatory bowel disease (IBD), both ulcerative colitis and Crohn’s disease of the colon, have an increased risk of developing colorectal cancer compared with individuals without IBD. A number of factors contribute to the increase in risk, which necessitates an individualised and sensible approach to surveillance in patients, according to a new medical position statement and technical review published by the American Gastroenterological Association in its official journal, Gastroenterology. “The increased risk of developing colorectal cancer in certain patients with IBD prompted the AGA to look at current diagnosis and management protocols to ensure that our patients are receiving the highest level of treatment,” said lead author Francis A. Farraye, MD, Boston Medical Center, Boston, Massachusetts. “The recommendations we developed will help guide gastroenterologists to identify high-risk individuals and develop surveillance plans based on each patient’s unique situation.” While IBD is relatively rare in the general population, it remains one of the 3 high-risk conditions predisposing patients to CRC, along with Lynch syndrome and familial adenomatous polyposis. Other findings of the medical position statement on diagnosis and management of CRC in IBD patients include: · Disease duration, more extensive disease, severity of inflammation, primary sclerosing cholangitis, and a positive family history of sporadic CRC are all associated with an increased risk of developing CRC. · Dysplasiadetected on biopsy is currently considered the best marker for CRC risk in IBD. · Patients with IBD and a non-adenoma-like dysplasia-associated lesion or mass that does not lend itself to being completely removed by colonoscopy should be treated with colectomy. In contrast, patients with an adenoma-like dysplasia-associated lesion or mass removed endoscopically and without evidence of flat dysplasia elsewhere in the colon, can be managed safely by polypectomy and continued surveillance. · There is a high certainty that colectomy for flat high-grade dysplasia treats undiagnosed synchronous cancer (which may be present in 42% to 67% of cases). · The controversy revolving around the management of low-grade dysplasia was reviewed. · There is moderate certainty that surveillance colonoscopy results in at least moderate reduction of CRC risk in patients with IBD. Patients with extensive ulcerative colitis or Crohn’s disease involving much of the colon are the most likely to benefit. · The authors endorsed the use of chromoendoscopy in high risk patients to identify dysplasia and cancer. · While there is some evidence that certain medicines used to treat IBD might help to prevent CRC and dysplasia, this requires further research. · At present, there are no genetic, molecular or biochemical markers that can be measured in the tissue, blood or stool to reliably predict which patients with IBD are at greater risk for dysplasia or cancer, but this is an area of active investigation. The conclusions of the technical review and medical position statement were based on the best available evidence, or in the absence of quality evidence, the expert opinions of the authors and medical position panel convened to critique the technical review and structure the medical position statement. The technical review and the medical position statement together represent the guideline. SOURCE: American Gastroenterological Association E-mail this page to a friend or colleague! To print, use this version