Guidance offered for managing colorectal dysplasia in patients with IBD

Among other best practice advice from the American Gastroenterological Association, precancerous colorectal lesions in patients with inflammatory bowel disease (IBD) should be described as polypoid, nonpolypoid, or invisible using a modified Paris Classification.

Precancerous colorectal lesions in inflammatory bowel disease (IBD) should be described as polypoid, nonpolypoid, or invisible using a modified Paris Classification, according to a clinical practice update from the American Gastroenterological Association (AGA), and the terms dysplasia-associated lesion or mass and adenoma-like mass should no longer be used.

In the clinical practice update, the AGA provided recommendations on the prevention, detection, and management of IBD-related dysplasia based on an expert review. The update was published Sept. 8 by Gastroenterology.

The 14 recommendations also included the following:

  • Visible precancerous lesions should be described by size, morphology, border clarity, presence of ulceration, location, presence within an area of past or current colitis, perceived completeness of resection, and whether any special techniques were used for visualization, the statement said.
  • Initial colonoscopy screening should begin eight to 10 years after the first diagnosis of colonic IBD and immediately after diagnosis of primary sclerosing cholangitis. The results of the first screening examination can help guide future surveillance intervals, according to the statement.
  • Following a negative screening, colonoscopy surveillance should be performed every one to five years depending on individual patients' risk factors, such as current and prior burden of colonic inflammation, family history of colorectal cancer, primary sclerosing cholangitis, history of colorectal dysplasia, and frequency and quality of prior surveillance examinations, the statement said.
  • Optimal disease control with medical therapy is imperative to minimizing a patient's lifetime risk of developing colorectal cancer, according to the statement. It also noted that the independent chemotherapeutic benefit of mesalamine therapy in patients with colonic IBD is uncertain.

The statement noted that improvements in disease management and endoscopic technology and quality have changed current thinking about IBD-related dysplasia, which is now more closely aligned with dysplasia in patients who do not have IBD. “We look forward to a day when a single guideline can potentially address dysplasia surveillance and management in IBD and non-IBD patients alike,” the authors wrote. “Until then, this document serves to summarize updated understanding and best practice advice for dysplasia management in IBD.”