What is the most appropriate time interval for surveillance in IBD patients?
The ideal surveillance interval has not been tested, nor has the impact of co-existing risk factors ever been assessed. Early surveillance programmes included patients with extensive UC who were subjected to biennial colonoscopy. In the St Mark’s series involving 600 patients with extensive UC who underwent 2627 colonoscopies at one to two yearly intervals during 5932 patient years of follow-up, 30 cancers developed of which 16 were “interval” cases. Itzkowitz and Harpazsuggested that surveillance should be conducted annually or biennially provided no dysplasia is found or suspected. Recommendations by the Crohn’s and Colitis Foundation of America (CCFA) state that surveillance intervals depend on initial biopsy findings. If the initial colonoscopy is negative for dysplasia, repeat colonoscopy should be performed every one to two years. After two negative colonoscopies further colonoscopies may be performed every one to three years until IBD has been present for 20 years, at which point surveillance colonoscopies should be repeated every one to two years. In contrast, patients found to have dysplasia on screening or surveillance colonoscopy require colectomy or more aggressive surveillance. Patients with co-existing PSC and IBD require annual surveillance colonoscopies. Although the impact of a family history of CRC on surveillance intervals in IBD has not been evaluated, both American and British guidelines recommend more frequent surveillance when this risk factor is present. The need to intensify surveillance after 20 years has been disputed by the results of the St Mark’s series, which showed a constant cancer incidence for up to 40 years of colitis duration and included a relatively large number of patients.
Evidence summary and recommendations
Annual colonoscopic surveillance is recommended for patients with ulcerative colitis extending proximal to the sigmoid colon or patients with Crohn’s colitis affecting more than one third of the colon and with one or more of the following risk factors:
Three yearly colonoscopy is recommended for patients with:
Five yearly colonoscopy recommended for patients in whom two previous colonoscopies that were macroscopically and histologically normal.
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