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Updated recommendations for the surveillance and management of dysplasia in patients in inflammatory bowel disease (IBD) have been issued by the American Society for Gastrointestinal Endoscopy (ASGE) and the American Gastroenterological Association (AGA). The consensus statement has been published in the journals GIE: Gastrointestinal Endoscopy and Gastroenterology.
The statement represents unified consensus recommendations on surveillance to detect dysplasia and management of dysplasia. The new recommendations encourage the use of chromoendoscopy for patients with IBD during screening and surveillance for improved tissue visualization.
The following statements are included, along with strength of statement, status as a recommendation, and background discussion:
- When performing surveillance with white-light colonoscopy, high definition is recommended rather than standard definition.
- When performing surveillance with standard-definition colonoscopy, chromoendoscopy is recommended rather than white-light colonoscopy.
- When performing surveillance with high-definition colonoscopy, chromoendoscopy is suggested rather than white-light colonoscopy.
- When performing surveillance with standard-definition colonoscopy, narrow-band imaging (NBI) is not suggested in place of white-light colonoscopy.
- When performing surveillance with high-definition colonoscopy, narrow-band imaging is not suggested in place of white-light colonoscopy.
- When performing surveillance with image-enhanced high-definition colonoscopy, narrow-band imaging is not suggested in place of chromoendoscopy.
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Statements related to management of dysplasia in the absence of endoscopically non-resectable lesions in patients with IBD include:
- After complete removal of endoscopically resectable polypoid dysplastic lesions, surveillance colonoscopy is recommended rather than colectomy.
- After complete removal of endoscopically resectable nonpolypoid dysplastic lesions, surveillance colonoscopy is suggested rather than colectomy.
- For patients with endoscopically invisible dysplasia (confirmed by a GI pathologist) referral is suggested to an endoscopist with expertise in IBD surveillance using chromoendoscopy with high-definition colonoscopy.
For more information visit gastro.org.
