Colorectal cancer screening and surveillance in patients with inflammatory bowel disease in 2021

Table 1 Risk factors for the development of colorectal cancer in patients with inflammatory bowel disease and recommended surveillance

	High risk	Intermediate risk	Low risk
Risk factors	(1) PSC; (2) Extensive involvement; (3) Moderate-severe active inflammation sustained over time (endoscopic or histological); (4) First-degree relative with CRC before age 50; (5) Stenosis or dysplasia detected during the previous five years; (6) Appearance of IBD at a young age; (7) If ileo-anal pouch: (a) Dysplasia; (b) Previous CRC; (c) PSC; and (d) Type C mucosa in the pouch	(1) Extensive colitis with mild or moderate sustained inflammatory activity (endoscopic or histological); (2) Inflammatory polyps; and (3) First-degree relative with CRC after age 50	(1) Factors other than high and intermediate risk; and (2) If ileo-anal pouch: Without risk factors
Surveillance	Annual	Every three years	Every five years

CRC: Colorectal cancer; IBD: Inflammatory bowel disease; PSC: Primary sclerosing cholangitis.

Table 2 SCENIC international consensus

Term	Definition
Visible dysplasia	Dysplasia identified on targeted biopsies from a lesion visualized in colonoscopy
Polypoid	Lesion protruding from the mucosa into the lumen ≥ 2.5 mm
Pedunculated	Lesion attached to the mucosa by a stalk
Sessile	Lesion not attached to the mucosa by a stalk: entire base is contiguous with the mucosa
Nonpolypoid	Lesion with little (< 2.5 mm) or no protrusion above the mucosa
Superficially elevated	Lesion with protrusion but < 2.5 mm above the lumen (less than the height of the closed cup of a biopsy forceps)
Flat	Lesion without protrusion above the mucosa
Depressed	Lesion with at least a portion depressed below the level of the mucosa
General descriptors
Ulcerated	Ulceration (fibrinous base with depth) within the lesion
Border
Distinct border	Border of the lesion is discrete and can be distinguished from surrounding mucosa
Indistinct border	Border of the lesion is not discrete and cannot be distinguished from surrounding mucosa
Invisible dysplasia	Dysplasia identified on random (non-targeted) biopsies of colon mucosa without a visible lesion

Table 3 Summary of endoscopic detection techniques

Technique	Recommendation	Future
Standard-definition colonoscopy	None	No longer used
High-definition white-light video colonoscopy and serial biopsies every 10 cm of the colon	Avoid	No longer used
High-definition white-light video colonoscopy with dye-spray chromoendoscopy (methylene blue or indigo carmine)	High	Second choice
High-definition white-light video colonoscopy with narrow-band imaging	High	First choice
Full-spectrum endoscopy	Await further evidence	Under investigation
Autofluorescence imaging	None	No longer used
Confocal laser endomicroscopy	Await further evidence	Under investigation
Endocytoscopy	Investigate	Investigate

Table 4 The Paddington International Virtual ChromoendoScopy ScOre in ulcerative colitis

PICaSSO Mucosal Architecture	PICaSSO Vascular Architecture
0 - No mucosal defect	0 - Vessels without dilatation
A: Continuous/regular crypts	A: Roundish following crypt architecture
B: Crypts not visible (scar)	B: Vessels not visible (scar)
C: Discontinuous and or dilated/elongated crypts	C: Sparse (deep) vessels without dilatation
I - Micro erosion or cryptal abscess	I - Vessels with dilatation
1: Discrete	A: Roundish with dilatation
2: Patchy	B: Crowded or tortuous superficial vessels with dilatation
3: Diffuse
II – Erosions, size < 5 mm	II - Intramucosal bleeding
1: Discrete	A: Roundish with dilatation
2: Patchy	B: Crowded or tortuous superficial vessels with dilatation
3: Diffuse
III – Ulcerations, size > 5 mm	III - Luminal bleeding
1: Discrete	A: Roundish with dilatation
2: Patchy	B: Crowded or tortuous superficial vessels with dilatation
3: Diffuse

PICaSSO: Paddington International Virtual ChromoendoScopy ScOre.