Colorectal cancer surveillance in patients with inflammatory bowel disease: What is new?

Table 1 Confirmed risk factors and proposed protective factors for developing colorectal cancer in inflammatory bowel disease patients

Confirmed risk factors	Protective factors under investigation
Extent of colitis[27]	5-ASA treatment[75-77]
UC pancolitis
UC left-sided colitis
CD colitis (> 50%)
Disease duration[19]	UDCA treatment[78-80]
Association with PSC[39-41]	Folate supplementation[82-84]
Family history of CRC[37,38]	Colectomy[81]
Active inflammation[34]	Maintaining of remission
Pseudopolyps	Mucosal healing
Strictures	Histological healing
Degree of histological inflammation

5-ASA: 5-aminosalicylate; UDCA: Ursodeoxycholic acid; UC: Ulcerative colitis; CD: Crohn’s disease; PSC: Primary sclerosing cholangitis; CRC: Colorectal cancer.

Table 2 Summary of the main differences in the recommendations for colorectal cancer surveillance programs in inflammatory bowel disease patients

Guidelines	Remission	Beginning of surveillance	Surveillance schedule	Random biopsy protocol	New endoscopic technique recommended
U.K. 2002[7]	Necessary	8-10 yr (pancolitis)	3 yr (2° decade)	Recommended	Not mentioned
		15-20 yr (left-sided colitis)	2 yr (3° decade)
			1 yr (4° decade)
AGA 2003[8]	Not mentioned	8 yr (pancolitis)	Every 1-2 yr	Recommended	Not mentioned
		15 yr (left-sided colitis)
ACG 2004[5]	Necessary	8-10 yr	Every 1-2 yr	Recommended	Not mentioned
ECCO 2008[4]	Necessary	8 yr (pancolitis)	2 yr (1°-2° decade)	Recommended	Chromoendoscopy
		15 yr (left-sided colitis)	- 1 yr (3° decade)
BSG 2010[6]	Necessary	10 yr	- 3 yr lower risk	Recommended	Chromoendoscopy
			- 2 yr intermediate risk
			- 1 yr higher risk

AGA: American Gastroenterological Association; ACG: American College of Gastroenterology; UK: United Kingdom; ECCO: European Crohn’s and Colitis Organization; BSG: British Society of Gastroenterology.