042). 24 In the surveillance group, 1 patient died as a consequence of CRC compared with 29 patients in the control group (P = .047) and more people with early tumor stage were found in the surveillance group (P = .004). All these studies could be subject to lead-time find more or selection bias; thus at present, unequivocal evidence of the benefit of colitis surveillance is lacking. Because IBD-CRC tends to occur earlier in life than in the general population, benefit estimated in years of life saved may be much greater in colitis patients: mathematical models of life-years saved per case screened ranges from 14 to 60 months in UC patients compared with 1 to 4 months in general population
screening.23 and 25 Most societies recommend colonoscopic surveillance to address the increased CRC risk. No screening program, however, can be 100% effective. The detection and treatment of colorectal dysplasia in IBD remains problematic and, despite surveillance programs, patients still present with interval cancers. This may be because lesions are missed or are incompletely excised, because patients or clinicians do not comply with surveillance guidelines, or
because aggressive de novo CRCs arise in between surveillance procedures. The appropriate surveillance frequency is necessarily Selleck ALK inhibitor a pragmatic balance of cost (both financial and in terms of patient inconvenience and risk) and benefit. It is important to focus resources on those most at risk and most likely to benefit from the program. This is best achieved by using the established risk factors (detailed previously), and guidelines are increasingly using these for patient risk stratification. Because duration of disease is a major risk factor for IBD-CRC, it is rational to commence surveillance colonoscopy when the risk starts to increase (ie, approximately 8–10 years after symptom onset).10 The subsequent surveillance interval should take into account the risk for dysplasia development and the time it takes for dysplasia to progress to CRC. Unfortunately, the rate of dysplasia progression in IBD is not well
established, although it undoubtedly varies between individuals. Therefore, intervals should be adjusted to individual patients according to their CRC risk factors.26 Because CRCs have been detected within Sulfite dehydrogenase 2 years of surveillance colonoscopy, yearly colonoscopy seems appropriate for patients with high risk factors. The appropriate frequency of surveillance for other patients is less clear. Dysplastic lesions, polypoid or nonpolypoid, occurring in an area that has not been affected by inflammation can be assumed to be sporadic adenomas unrelated to the colitis and can be resected endoscopically. Dysplasia within inflamed or previously inflamed mucosa is important because it may progress more rapidly than adenomas in noninflamed mucosa.27 Thus, all such lesions should be removed promptly.