Role of endoscopy in the surveillance and management of colorectal neoplasia in inflammatory bowel disease

Table 1 Risk factors for the development of dysplasia in inflammatory bowel disease

Risk factors	Endoscopic factors
Disease duration	Active disease
Disease extent	Presence of strictures in ulcerative colitis
Disease severity	Post inflammatory polyps
Past dysplasia	Tubular appearance of colon with loss of colonic haustration
Primary sclerosing cholangitis
Family history of colorectal cancer

Table 2 Commonly used guidelines for the screening of neoplasia in inflammatory bowel disease

Society	Commencement	Risk stratification	Interval
ECCO, 2017	8 yr post symptom onset	Stricture or dysplasia, PSC, extensive colitis, severe active inflammation	Annual
		Mild to moderate active inflammation, post inflammatory polyps, or first degree relative with CRC	2-3 yr
		None of the above features	5 yr
AGA, 2010	8 yr post diagnosis	Active inflammation, stricture, post inflammatory polyps, history of dysplasia, first degree relative with CRC, PSC	Annual
		After 2 negative colonoscopies	1-3 yr
ACG, 2010	8-10 yr post diagnosis	No risk stratification	1-2 yr
BSG, 2010	10 yr post symptom onset	Moderate/severe active inflammation on the prior colonoscopy, stricture, dysplasia, PSC, first degree relative with CRC aged < 50 yr	Annual
		Mild active inflammation on prior colonoscopy, post inflammatory polyps, first degree relative with CRC aged > 50 yr	3 yr
		Nil prior inflammation, left sided colitis or CD colitis affecting > 50% surface area of the colon	5 yr

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

Table 3 Low, intermediate, and high risk features to risk stratify patients and guide surveillance intervals

Low risk	Intermediate risk	High risk
Quiescent disease, even with extensive colonic involvement; left sided IBD	Extensive colonic involvement with mild inflammation; post inflammatory polyps; CRC in 1st degree relative aged > 50	Extensive colitis with moderate/severe inflammation; primary sclerosing cholangitis; colonic strictures1; dysplasia of any grade1; CRC in 1st degree relative aged < 50

¹In particular if in the prior 5 years.

Table 4 SCENIC consensus nomenclature of dysplasia in inflammatory bowel disease

Term	Definition
Visible dysplasia	Dysplasia confirmed histologically on a targeted biopsy
Invisible dysplasia	Dysplasia on a random biopsy
Polypoid	Lesion protruding ≥ 2.5 mm into the lumen
Non polypoid	Lesion protruding < 2.5 mm into the lumen or not protruding
Superficial elevated	Protrusion < 2.5 mm
Pedunculated	Attached to mucosa via stalk
Sessile	Not attacked via stalk; base contiguous with mucosa
Flat	No protrusion above mucosa
Depressed	At least a portion of lesion depressed below mucosa
Ulcerated	Fibrinous appearing base within lesion
Distinct border	Easily identified from surrounding mucosa
Indistinct border	Not discrete; difficult to distinguish from surrounding mucosa