British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease

James Edward East¹, Morris Gordon², Gaurav Bhaskar Nigam³, Vassiliki Sinopoulou², Adrian C Bateman⁴, Shahida Din^{5

6}, Marietta Iacucci⁷, Misha Kabir⁸, Christopher Andrew Lamb^{9

10}, Ana Wilson^{11

12}, Ibrahim Al Bakir¹³, Anjan Dhar^{14

15}, Sunil Dolwani¹⁶, Omar Faiz^{17

18}, Ailsa Hart^{11

12}, Bu'Hussain Hayee¹⁹, Chris Healey²⁰, Simon John Leedham^{3

21}, Marco R Novelli²², Tim Raine²³, Matthew D Rutter²⁴, Neil A Shepherd²⁵, Venkataraman Subramanian^{26

27}, Margaret Vance¹¹, Ruth Wakeman²⁸, Lydia White³, Nigel J Trudgill^{29

30}, A John Morris³¹

Affiliations

¹ Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK james.east@ndm.ox.ac.uk.
² School of Medicine, University of Central Lancashire, Preston, UK.
³ Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
⁴ Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, Hampshire, UK.
⁵ The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.
⁶ Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
⁷ APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland.
⁸ Division of Gastrointestinal Services, University College Hospitals NHS Trust, London, UK.
⁹ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
¹⁰ Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹¹ Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK.
¹² Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
¹³ Gastroenterology Department, Chelsea and Westminster Hospital, London, UK.
¹⁴ Department of Gastroenterology, Darlington Memorial Hospital, Darlington, Durham, UK.
¹⁵ Teesside University, Middlesbrough, UK.
¹⁶ Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
¹⁷ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁸ Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, London, UK.
¹⁹ King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.
²⁰ Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK.
²¹ Stem Cell Biology Lab, Centre for Human Genetics, University of Oxford, Oxford, UK.
²² Department of Histopathology, University College London, London, UK.
²³ Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.
²⁴ Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK.
²⁵ Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, Gloucestershire, UK.
²⁶ Department of Gastroenterology, St James's University Hospital, Leeds, UK.
²⁷ Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
²⁸ Crohn's and Colitis UK, Hatfield, UK.
²⁹ Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK.
³⁰ Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
³¹ Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.

PMID: 40306978
DOI: 10.1136/gutjnl-2025-335023

Free article

British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease

James Edward East et al. Gut. 2025.

Free article

. 2025 Apr 30:gutjnl-2025-335023.

doi: 10.1136/gutjnl-2025-335023. Online ahead of print.

Authors

Affiliations

¹ Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK james.east@ndm.ox.ac.uk.
² School of Medicine, University of Central Lancashire, Preston, UK.
³ Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
⁴ Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, Hampshire, UK.
⁵ The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.
⁶ Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
⁷ APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland.
⁸ Division of Gastrointestinal Services, University College Hospitals NHS Trust, London, UK.
⁹ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
¹⁰ Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹¹ Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK.
¹² Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
¹³ Gastroenterology Department, Chelsea and Westminster Hospital, London, UK.
¹⁴ Department of Gastroenterology, Darlington Memorial Hospital, Darlington, Durham, UK.
¹⁵ Teesside University, Middlesbrough, UK.
¹⁶ Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
¹⁷ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁸ Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, London, UK.
¹⁹ King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.
²⁰ Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK.
²¹ Stem Cell Biology Lab, Centre for Human Genetics, University of Oxford, Oxford, UK.
²² Department of Histopathology, University College London, London, UK.
²³ Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.
²⁴ Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK.
²⁵ Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, Gloucestershire, UK.
²⁶ Department of Gastroenterology, St James's University Hospital, Leeds, UK.
²⁷ Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
²⁸ Crohn's and Colitis UK, Hatfield, UK.
²⁹ Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK.
³⁰ Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
³¹ Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.

PMID: 40306978
DOI: 10.1136/gutjnl-2025-335023

Abstract

Patients with inflammatory bowel disease (IBD) remain at increased risk for colorectal cancer and death from colorectal cancer compared with the general population despite improvements in inflammation control with advanced therapies, colonoscopic surveillance and reductions in environmental risk factors. This guideline update from 2010 for colorectal surveillance of patients over 16 years with colonic inflammatory bowel disease was developed by stakeholders representing UK physicians, endoscopists, surgeons, specialist nurses and patients with GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodological support.An a priori protocol was published describing the approach to three levels of statement: GRADE recommendations, good practice statements or expert opinion statements. A systematic review of 7599 publications, with appraisal and GRADE analysis of trials and network meta-analysis, where appropriate, was performed. Risk thresholding guided GRADE judgements.We made 73 statements for the delivery of an IBD colorectal surveillance service, including outcome standards for service and endoscopist audit, and the importance of shared decision-making with patients.Core areas include: risk of colorectal cancer, IBD-related post-colonoscopy colorectal cancer; service organisation and supporting patient concordance; starting and stopping surveillance, who should or should not receive surveillance; risk stratification, including web-based multivariate risk calculation of surveillance intervals; colonoscopic modalities, bowel preparation, biomarkers and artificial intelligence aided detection; chemoprevention; the role of non-conventional dysplasia, serrated lesions and non-targeted biopsies; management of dysplasia, both endoscopic and surgical, and the structure and role of the multidisciplinary team in IBD dysplasia management; training in IBD colonoscopic surveillance, sustainability (green endoscopy), cost-effectiveness and patient experience. Sixteen research priorities are suggested.

Keywords: COLONOSCOPY; COLORECTAL CANCER SCREENING; COLORECTAL NEOPLASIA; ENDOSCOPY; IBD.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form. The following competing interests are reported: AH has received consulting fees, lecture fees, honoraria, or advisory board fees from AbbVie, Abivax, BMS, Celltrion, Falk, GSK, Eli Lilly, J&J, Pfizer, and Takeda. She is a governing board member of ECCO (since 2018) and a scientific board member of Crohn's and Colitis UK (since 2011). AD has received honoraria, advisory fees, consultancy fees, speaker fees and hospitality from Tillotts Pharma (UK), Dr Falk Pharma UK, Takeda, BMS, Lilly, Abbvie UK, Pharmacosmos UK, Johnson and Johnson, Celltrion, Amgen, Alfasigma and Boston Scientific Corporation Inc. CH is employed as a JAG assessor, with JAG using standards to guide the assessment of endoscopy units for accreditation.CAL has provided consultancy for MSD, Eli Lilly, Janssen and BMS, and has received honoraria for educational activities from Takeda, Ferring, Janssen, Dr Falk and Nordic Pharma. He has also received conference attendance support from Tillotts Pharma UK, Janssen, BSG, IOIBD and ECCO. CAL is a steering committee and board member of IBD UK and was secretary of the IBD section committee of the British Society of Gastroenterology (2021–2024). AB has received lecture and advisory board fees from Dr Falk and is the secretary of the colorectal section of the BSG. AJM has received speaker honoraria from AstraZeneca and Medtronic and conference attendance support from Tillotts Pharma.LW has served on advisory boards for Pfizer, BMS and Dr Falk and has received speaker’s honoraria from Takeda, Eli Lilly, Galapagos and BMS. She has also received conference attendance support from Ferring and Eli Lilly and receives editorial royalties for the Inflammatory Bowel Disease Nursing Manual. MI has received grants from the Helmsley Charitable Trust, Eli Lilly and Olympus, as well as payments for lectures or educational events from Pentax, Eli Lilly, and Pfizer. Additionally, she has received equipment or materials support from Pentax. MDR is the regional endoscopy advisor for NHS England (since 2021) and chair of JAG (since 2023).MG serves as an editor for Cochrane, supporting clinical truth-unbiased synthesis (ongoing). NJT serves on the advisory board for Dr Falk UK concerning eosinophilic esophagitis and Jorveza, and his department receives research support, speaker fees and conference attendance support from Dr Falk UK. RW is an employee of Crohn's & Colitis UK (since October 2019). SDi is chair of the BSG IBD section (2024–2027) and holds roles in the Scottish Government and MHRA advisory groups, as well as being a gastroenterology specialty advisor for the Royal College of Physicians. SJL has received research grants from UCB Pharma. TR has undertaken paid consultancy for various pharmaceutical companies since 2020 and is a director of Endoread Ltd (since 2022). JEE serves on clinical advisory boards for Exact Sciences, Cosmo Pharmaceuticals and Satisfai Health, holds share options in Satisfai Health, and has received speaker fees from Falk, Janssen and Medtronic.All other authors declare no competing interests.

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British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease

Affiliations

British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease

Authors

Affiliations

Abstract

Conflict of interest statement

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Full Text Sources