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Review
. 2024 Oct 15;18(10):1726-1735.
doi: 10.1093/ecco-jcc/jjae071.

Management of Colorectal Neoplasia in IBD Patients: Current Practice and Future Perspectives

Monica E W Derks  1 , Maarten Te Groen  1 , Lisa M A van Lierop  1   2 , Sanjay Murthy  3 , David T Rubin  4 , Talat Bessissow  5 , Iris D Nagtegaal  6 , Willem A Bemelman  7 , Lauranne A A P Derikx  8 , Frank Hoentjen  1   2
Affiliations
Review

Management of Colorectal Neoplasia in IBD Patients: Current Practice and Future Perspectives

Monica E W Derks et al. J Crohns Colitis. .

Abstract

Inflammatory bowel disease [IBD] patients are at increased risk of developing colorectal neoplasia [CRN]. In this review, we aim to provide an up-to-date overview and future perspectives on CRN management in IBD. Advances in endoscopic surveillance and resection techniques have resulted in a shift towards endoscopic management of neoplastic lesions in place of surgery. Endoscopic treatment is recommended for all CRN if complete resection is feasible. Standard [cold snare] polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection should be performed depending on lesion complexity [size, delineation, morphology, surface architecture, submucosal fibrosis/invasion] to maximise the likelihood of complete resection. If complete resection is not feasible, surgical treatment options should be discussed by a multidisciplinary team. Whereas [sub]total and proctocolectomy play an important role in management of endoscopically unresectable CRN, partial colectomy may be considered in a subgroup of patients in endoscopic remission with limited disease extent without other CRN risk factors. High synchronous and metachronous CRN rates warrant careful mucosal visualisation with shortened intervals for at least 5 years after treatment of CRN.

Keywords: Crohn’s disease; Inflammatory bowel disease; colorectal cancer; colorectal neoplasia; surveillance; ulcerative colitis.

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Conflict of interest statement

The authors state no conflict of interest. MG has served as a speaker for Abbvie. TB acted as a speaker or adviser for Abbvie, Alimentiv, Amgen, Bristol-Myers-Squibb, Eli Lilly, Ferring, Fresenius Kabi, Gilead, Janssen, Merck, Pentax, Pfizer, Roche, Sandoz, Sanofi, Takeda, Viatris. LD has served on advisory boards or as speaker for Abbvie, Janssen, Sandoz, Galapagos and has received independent research funding from Pfizer. FH has served on advisory boards or as speaker for Abbvie, Janssen, MSD, Takeda, Pfizer, Celltrion, Teva, Sandoz, Amgen and Pendopharm, and has received independent research funding from Janssen, Abbvie, Pfizer, and Takeda.

Figures

Figure 1
Figure 1
Therapeutic management of colorectal neoplasia in IBD patients * If complete endoscopic resection is not feasible, surgical treatment options should be discussed in a multidisciplinary team. CRC, colorectal cancer; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; PSC, primary sclerosing cholangitis; HGD, high-grade dysplasia; LGD, low-grade dysplasia; IND, indefinite for dysplasia.
Figure 2
Figure 2
Endoscopic images. A: Low-risk lesion. B: High-risk lesion [> 1 cm, laterally spreading]. C: Endoscopically unresectable lesion [central depression with ulcer].
Figure 3
Figure 3
Flowchart for endoscopic surveillance. LGD, low-grade dysplasia; R0, micro- and macroscopically complete resection; R1, microscopically detected dysplastic cells close to or at the resection margins; R2, macroscopic residual lesion. * After surgical resection: continue surveillance in case of a residual colon or rectum. Annual pouch surveillance should be performed in case of prior colorectal neoplasia.
See this image and copyright information in PMC

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