Associate Editor Dr. Seth Gross highlights this article “SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease” by Loren Laine, MD, Tonya Kaltenbach, MD, Alan Barkun, MD, Kenneth R. McQuaid, MD, Venkataraman Subramanian, MD, and Roy Soetikno, MD for the SCENIC Guideline Development Panel as March’s Editor’s Choice.
The article nicely summarizes the approach of dysplasia management in patients with inflammatory bowel disease.
This consensus statement provides evidence-based recommendation for detection of dysplasia during colonoscopy in the IBD patient. The manuscript also gives management recommendations of dysplasia after being identified during a colonoscopy.
There are several key take home points in the article for surveillance and management of the IBD patient. Two points that stood out are the following:
- Surveillance colonoscopy should be performed with high-definition white light and not standard definition.
- After a dysplastic lesion is removed in an a patient with IBD, surveillance colonoscopy should be favored over colectomy.
Figure 3. A, 3-cm, nonpolypoid, superficial, elevated lesion after indigo carmine chromoendoscopy. B, The area of the lesion before dye spray. C, The same lesion had likely been photographed approximately a year earlier (on fold to left of ulcer), but it was not recognized to be dysplastic. Histologic examination showed low-grade dysplasia.
In the March issue of GIE, a group of IBD experts provides a highly important set of consensus recommendations on the detection and management of dysplasia in IBD. Using widely accepted methods of systematic review and consensus guidelines, the panel made recommendations that will likely change the practice of IBD surveillance. The key recommendations are for the use of high definition colonoscopy and chromoendoscopy to highlight areas for targeted biopsy and polypectomy. There is now substantial evidence that chromoendoscopy, with topical application of indigocarmine or methylene blue, improved detection of dysplasia. Newer, simplified methods (https://www.youtube.com/watch?v=6PJ91qYUPcE) also reduce the extra time needed for this procedure, particularly when it avoids the need for random biopsy.
The second set of major recommendations provides guidance for polypoid and flat dysplasia, which can be managed as with any sporadic polypoid or flat polyp, with polypectomy. A key new recommendation regards “invisible” dysplasia (i.e., a biopsy taken from a “random” site not noted to be abnormal endoscopically), which should be referred for a second look colonoscopy by a physician with expertise in chromoendoscopy prior to referral for surgery.
Together, this document, and the training necessary to expand expertise in chromoendoscopy, has the potential to reduce missed cancers and also avoid unnecessary surgery in patients in whom a polypectomy may suffice. We congratulate the SCENIC authors and their supporters on this important document.
Michael B. Wallace, MD, MPH, FASGE
GIE: Gastrointestinal Endoscopy
Find the full PDF of the article here.
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