The Role of Chromoendoscopy and Enhanced Imaging Techniques in Inflammatory Bowel Disease Colorectal Cancer Colonoscopy Surveillance

Patients with a long-standing ulcerative colitis (UC) and extensive Crohn’s disease (CD) colitis have an approximately twofold higher risk of developing colorectal cancer. Increased duration and extent of colonic involvement contribute to the level of risk and unfortunately are not modifiable. A majority of gastrointestinal professional societies have recommended colonoscopy for the surveillance of patients with inflammatory bowel disease (IBD). Despite surveillance, IBD patients with colitis continue to be at risk for colorectal cancer secondary to missed and unrecognized dysplastic lesions at colonoscopy. Until recently, the random sampling of mucosa throughout the colon has been the primary method of surveillance. This approach to colonoscopy surveillance in IBD has been ineffective, time-consuming, and expensive and has a low diagnostic yield. According to the latest studies, most dysplastic lesions are visible to careful endoscopic inspection. This has led to a more focused approach in surveillance colonoscopy, mainly targeted biopsies of any mucosal abnormalities using chromoendoscopy (CE) and other enhanced imaging techniques including high-definition endoscopy, confocal laser endomicroscopy, endocytoscopy, and molecular imaging.