Evolving endoscopic strategies for detection and treatment of neoplastic lesions in inflammatory bowel disease

摘要

Colorectal cancer (CRC) is a serious potential complication of inflammatory bowel disease (IBD). Regular surveillance colono-scopy to diagnose early neoplasia is currently the main approach to CRC prevention in IBD. Traditional surveillance recommendations advocate obtaining interval random biopsy specimens throughout the colon because IBD patients have a propensity toward the development of flat and subtle neoplasms that may evade detection and rapidly progress to advanced CRC. Total proctocolectomy is further recommended for the treatment of advanced precancerous lesions in IBD, including a dysplasia-associated lesion or mass (DALM) and high-grade intraepithelial neoplasia (HG-IEN). However, newer endoscopic technologies, including high-definition endos-copy, chromoendoscopy, narrow-band imaging (NBI), and confocal laser endomicroscopy, have significantly improved the detection and characterization of neoplastic lesions and have the potential to alter the surveillance paradigm in IBD in favor of targeted neoplasia detection with endoscopic resection of even advanced precancerous lesions.