SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2023 | VOLUME 21 | ISSUE 1 | 6 Established factors associated with the risk of CRC in patients with IBD 18, 19 a) Patient related factors i) Males ii) Young age at UC diagnosis iii) First degree relative diagnosed with CRC (not IBD) between the ages of 50-55 years. b) Disease related factors i) Extensive disease defined as >50% of colonic involvement in CD, or extensive disease in UC (2-3 times increased risk). ii) Inflammation extending proximally up to the splenic flexure at any time in the course of the disease. iii) Concomitant primary sclerosing cholangitis (PSC) (3-5 times increased risk). iv) Long standing disease – the risk is higher after 8-10 years disease. v) Cumulative inflammatory burden (CIB), not absolute disease duration per se. vi) History of dysplasia - due to the phenomenon of field cancerization, the risk of metachronous and synchronous cancer is higher in areas of previous of current inflammation. vii)Stricturing disease Screening for CRC in IBD patients Considering the peculiar phenotype of IBD-associated CRC, specific guidelines for screening (considered as the first colonoscopy after diagnosis) and surveillance (subsequent colonoscopies) for CRC have been published. Although there are minor differences between them, there is consensus on the timing and tools of surveillance. Figure 2. depicts guidelines from the European Crohn’s Colitis Organization (ECCO) 19 . These differ slightly from those by the American Gastroenterological Association (AGA) that recommends first screening at 8-10 years after the onset of symptoms, with surveillance at 1-2 yearly intervals irrespective of risk stratification (except in patients with PSC) 20 . Figure 2: Endoscopic screening and surveillance for CRC in IBD *HDWLE, high-definition white light endoscopy; DCE, dye-based chromoendoscopy; VCE, virtual electronic chromoendoscopy (VCE); PSC, primary sclerosing cholangitis. Adapted from Gordon, H., et al 19 • Colitis affecting <50% of colon • Extensive colitis with minimal endoscopic or histological inflammation • Recommendation: screening every 5 years Low Risk Intermediate Risk High Risk NB: Screening colonoscopy should be offered to all lBD patients 8 years after the onset of symptoms • Extensive colitis with mild to moderate endoscopic and/or histological inflammation • Colorectal cancer in first degree relative >50 years of age • Recommendation: screening every 2-3 years • Extensive colitis with severe endoscopic and/or histological inflammation. • Colorectal cancer in first degree relative <50 years of age • IBD with PSC or post orthotopic liver transplant • Pouch surveillance with prior CRC or dysplasia, moderate to severe pouchitis • Recommendation: screening annually When possible, screening colonoscopy should be done when the patient is in remission, using DCE, VCE or HDWLE with targeted biopsies