Colonoscopy, tumors and inflammatory bowel disease

Changing the endoscopic paradigm for the detection, characterization and endoluminal therapy of intraepithelial neoplasia, colitis-associated cancer and inflammatory extent assessment

Previous studies have prospectively evaluated the efficacy of high-magnification chromoscopic colonoscopy (HMCC) and endoscopic mucosal resection (EMR) for the detection and treatment of sporadic adenomas and early neoplastic colorectal lesions [1]. However, the management and clinical interpretation of dysplasia in the context of chronic ulcerative colitis (CUC) is radically different to that of sporadic dysplastic lesions in the “normal” population [2] [3]. At the current time, dysplasia is the most reliable biomarker of malignant change, being present in over 70 % of CUC patients with colorectal cancer [4]. Emerging data suggest that intraepithelial neoplasia (IN) is easily missed using conventional “white light” colonoscopy and current colorectal cancer (CRC) screening protocols. Emerging data now also suggest that simple polypectomy of adenoma-like mass (ALM) may be an adequate endoluminal therapy for CRC secondary prevention in this group - a radical paradigm shift away from total colectomy [5]. Furthermore, colonoscopy with mucosal biopsy, currently considered the “gold standard” investigation for the evaluation of disease activity and extent in ulcerative colitis (an important risk factor for IN development in CUC), may now be accurately predicted in vivo using high magnification chromoscopic techniques (HMCC) [6].

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