Colorectal cancer surveillance in inflammatory bowel disease: A critical analysis

Table 1 Risk of colorectal cancer in inflammatory bowel disease

Ref.	Type of study	Risk in UC	Risk in CD	Odds ratio (95%CI)	Comments
Eaden et al[8] 2001	Meta-analysis 116 studies; 41 mentioned duration of UC	3.7%		NA	2% at 10 yr, 8% at 20 yr, 18% at 30 yr
Jess et al[9] 2006	Population-based	6/378 (1.6%)	6/314 (1.9%)	SIR UC: 1.1 (0.4-2.4) CD: 1.9 (0.7-4.1)	Cumulative cancer risk 2% at 20 yr
Rutter et al[10] 2006	Hospital-based retrospective	3/600 (0.5%)	NA	NA	2.5% at 20 yr, 7.6% at 30 yr, 10.8% at 40 yr
Jess et al[11] 2012	Meta-analysis of 8 population-based (1958-2004)	1.6% (14 yr follow-up)	NA	Pooled SIR: 2.4 (2.1-2.7)	Risk of in patients with UC over
Lutgens et al[12] 2013	Meta-analysis (1988-2009)			IBD pooled SIR Population based: 1.7 (1.2-2.2)Referral based: 5.3 (2.8-7.8)
Jess et al[13] 2012	Population-based			RR for CRC- UC1979-1988: 1.34 (1.13-1.58) 1989-1998: 1.09 (0.9-1.33)1999-2008: 0.57 (0.41-0.80) RR for CRC in CD: 0.85 (0.67-1.07), which did not change over time	CRC risk in UC reduced over three decades and comparable to general population;CD no change
Herrinton et al[14] 2012	Hospital-based	UC 53 /10895CD 29/5603		UC: 1.6 (1.3-2.0) CD: 1.6 (1.2-2.0)	CRC risk in UC and CD 60% higher than population
Asian studies
Gilat et al[15] 1988	Population-based (central Israel)		NA		CRC risk in UC: 0.2% at 10 yr, 5.5% at 20 yr, 13.5% at 30 yr
Kochhar et al[16] 1992	Hospital-based (India)	UC 1.8%	NA
Venkataraman et al[17] 2005	Hospital-based (India)	UC 0.94%
Kim et al[19] 2009	Population-based (South Korea)	UC 0.50%
Kekilli et al[20] 2010	Hospital-based (Turkey)	UC 1.10%
Gong et al[21] 2012	Hospital-based (China)	UC 0.87%

CD: Crohn’s disease; FH: Family history; IBD: Inflammatory bowel disease; NA: Not applicable; PSC: Primary sclerosing cholangitis;

Table 2 Guidelines of various societies on surveillance for colorectal cancer in ulcerative colitis

Society	Year	Beginning of surveillance	Frequency	Technique	Biopsy protocol	Risk	Change
BSG	2002	All patients have colonoscopy screening at 8-10 yr; surveillance begins 8-10 yr after onset for pancolitis, 15-20 yr for left-sided colitis	Decrease in surveillance interval with increase in disease duration for pancolitis:Every 3 yr: 2nd decadeEvery 2 yr: 3rd decadeEvery 1 yr: 4th decade	Nil	2-4 random biopsies every 10 cm from the entire colon	Patients with PSC, including those with OLT, should have annual screening
AGA	2004	8-10 yr	Every 1-2 yr	Nil
ACG	2004	8-10 yr	Every 1-2 yr	Nil
ECCO	2008	8 yr for pancolitis, 15 yr for left-sided colitis	Every 2 yr: 1st two decadesEvery 1 yr: 3rd decade	CE
BSG	2010	10 yr	Based on extent of disease, endoscopic and histologic activity, FH of CRC, presence of PSC, pseudopolyps, stricture, dysplasia on biopsy:Every 3 yr: low riskEvery 2 yr: intermediate riskEvery 1 yr: high risk	CE	Random biopsies every 10 cm and biopsies from raised/suspicious areas on CE	Patients with PSC, including those with OLT, should have annual screening	If dysplastic polyp within area of inflammation can be removed entirely, colectomy is not necessary
AGA	2010	8-10 yr	Every 1-2 yrIf two examinations are negative, then every 1-3 yr up to 20 yr, then every 1-2/yr	CE		Patients with PSC, including those with OLT, should have annual screening
NICE	2011	10 yr	As per BSG 2010 guidelines	CE
Australian	2011	8-10 yr	As per BSG 2010 guidelines	CE
ECCO	2013	6-8 yr, 8-10 yr	Same as BSG	CE

ACG: Association of Coloproctology for Great Britain and Ireland; AGA: American Gastroenterological Association; BSG: British Society of Gastroenterology; CE: Chromoendoscopy; CRC: Colorectal cancer; ECCO: European Crohn’s and Colitis Organization; FH: Family history; NICE: National Institute for Health and Clinical Excellence; OLT: Orthotopic liver transplantation; PSC: Primary sclerosing cholangitis.

Table 3 Endoscopic dysplasia-detection modalities in patients with inflammatory bowel disease and recommendations for use[39]

	Demonstrated accuracy in IBD	Supporting evidence in IBD	Incorporated into guidelines	Practicality of use in practice	Should be used in 2013?
Random biopsy	-	-	+	±	±
HD WLE	+	±	+	+	+
Chromoendoscopy	+	+	+	+	+
NBI	-	-	-	±	-
FICE	NA	NA	-	±	-
i-Scan	NA	NA	-	±	-
AFI	+	+	-	-	-

AFI: Auto-fluorescence imaging; HD WLE: High-definition white light endoscopy; FICE: Fuji intelligent chromoendoscopy; IBD: Inflammatory bowel disease; NA: Not available; NBI: Narrow-band imaging. Reproduced with permission[39].