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Derks MEW, te Groen M, van Lierop LMA, Murthy S, Rubin DT, Bessissow T, Nagtegaal ID, Bemelman WA, Derikx LAAP, Hoentjen F. Management of Colorectal Neoplasia in IBD Patients: Current Practice and Future Perspectives. J Crohns Colitis 2024; 18:1726-1735. [PMID: 38741227 PMCID: PMC11479698 DOI: 10.1093/ecco-jcc/jjae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 05/13/2024] [Indexed: 05/16/2024]
Abstract
Inflammatory bowel disease [IBD] patients are at increased risk of developing colorectal neoplasia [CRN]. In this review, we aim to provide an up-to-date overview and future perspectives on CRN management in IBD. Advances in endoscopic surveillance and resection techniques have resulted in a shift towards endoscopic management of neoplastic lesions in place of surgery. Endoscopic treatment is recommended for all CRN if complete resection is feasible. Standard [cold snare] polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection should be performed depending on lesion complexity [size, delineation, morphology, surface architecture, submucosal fibrosis/invasion] to maximise the likelihood of complete resection. If complete resection is not feasible, surgical treatment options should be discussed by a multidisciplinary team. Whereas [sub]total and proctocolectomy play an important role in management of endoscopically unresectable CRN, partial colectomy may be considered in a subgroup of patients in endoscopic remission with limited disease extent without other CRN risk factors. High synchronous and metachronous CRN rates warrant careful mucosal visualisation with shortened intervals for at least 5 years after treatment of CRN.
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Affiliation(s)
- Monica E W Derks
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten te Groen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisa M A van Lierop
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sanjay Murthy
- Ottawa Hospital IBD Center and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL, USA
| | - Talat Bessissow
- Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam University Medical Center, AMC, Amsterdam, The Netherlands
| | | | - Frank Hoentjen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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The Fate of Unifocal Versus Multifocal Low-Grade Dysplasia at the Time of Colonoscopy in Patients With IBD: Erratum. Dis Colon Rectum 2022; 65:e825. [PMID: 35661081 DOI: 10.1097/dcr.0000000000002521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Macleod A, Kavalukas SL, Scheurlen KM, Galandiuk S. State-of-the-art surgery for Crohn's disease: Part II-colonic Crohn's disease and associated neoplasms. Langenbecks Arch Surg 2022; 407:2595-2605. [PMID: 35729401 DOI: 10.1007/s00423-022-02572-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022]
Abstract
Despite advances in medical therapy, surgery continues to play a vital role in the management of Crohn's disease and its complications. Continuing from Part I of this series (small intestine/ileal disease), we focus next on colonic Crohn's disease and associated neoplasms. We will first review the surgical management of medical-refractory Crohn's colitis and its complications and then examine cancer risk, surveillance, and surgical management of Crohn's-associated colorectal dysplasia and malignancy. We conclude with a discussion of restoration of gastrointestinal continuity following colonic surgery for Crohn's disease.
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Affiliation(s)
- Anne Macleod
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA
| | - Sandra L Kavalukas
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA.,Division of Colon & Rectal Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson St, Louisville, KY, 40202, USA
| | - Katharina M Scheurlen
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA
| | - Susan Galandiuk
- Hiram C. Polk, Jr MD Department of Surgery, Price Institute of Surgical Research, University of Louisville, Louisville, KY, 40292, USA. .,Division of Colon & Rectal Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson St, Louisville, KY, 40202, USA.
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