WORLD GASTROENTEROLOGY NEWS Official e-newsletter of the World Gastroenterology Organisation VOL. 21, ISSUE 4 FEBRUARY 2017 In this issue www.worldgastroenterology.org Colorectal dysplasia in patients with inflammatory bowel diseases Haleh Vaziri, MD Assistant Professor of Medicine Director, Inflammatory Bowel Disease Center Associate Director, Gastroenterology-Hepatology Fellowship Program University of Connecticut Health Center Department of Medicine Division of Gastroenterology and Hepatology Welcome to WDHD 2017 Inflammatory Bowel Disease (IBD): Navigating Evolving Therapies in an Evolving Disease Charles Bernstein, MD The increased incidence of colorectal cancer (CRC) among patients with inflammatory bowel disease (IBD) drives the quest for an optimal dysplasia surveillance program. Risk factors for CRC in patients with IBD include the presence of extensive or pan-colitis, longer duration of disease, concomitant diagnosis of primary sclerosing cholan-gitis, family history of CRC, young age at the time of diagnosis and most importantly a personal history of dysplasia1. The optimal surveillance strategy in IBD patients is controversial. The incidence of dysplasia in IBD patients appears to be lower2 than had been previously reported3. Ini-tial surveillance guidelines recommended annual or biennial colonoscopy with biopsy or resection of suspicious lesions and 4-quadrant random biopsies every 10 centimeters4 based upon the belief that dysplasia was mostly invisible 5 A central limitation of this strategy was that at least 33 biopsies were required to achieve 90% sensitivity for dyspla-sia detection6. Furthermore, with the advent of high-definition white light endoscopy (WLE), most dysplasia in IBD patients became endoscopically detectable8. Excellent bowel preparations with split-dosing bowel purgatives additionally improved the vis-ibility of dysplastic lesions. As a result, the utility of random colon biopsies was debated given the low yield of these biopsies and the rarity of invisible dysplasia7 . Nevertheless, it appears that random biopsies can still identify dysplasia that is invisible even with high-definition WLE8,9 and approximately 1.5% of patients with dysplasia would be missed if random biopsies were abandoned9. Recently, the introduction of chromoendoscopy (CE) has revolutionized the sur-veillance of IBD patients. During CE, a topical dye is sprayed on the colonic mucosa Continued on page 4 Chioma Ihunnah, MD, MPH Gastroenterology & Hepatology Fellow University of Connecticut Health Center Department of Medicine Division of Gastroenterology & Hepatology A Celebration of Gastro 2016: EGHS-WGO International Congress! Dr. Maryam Al Khatry Prof. James Toouli
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