The document discusses guidelines for endoscopy in patients with inflammatory bowel disease (IBD). It recommends screening beginning at 8-10 years after symptom onset, then risk-stratified surveillance. Chromoendoscopy, using dyes to enhance mucosal features, detects more dysplasia than standard white light endoscopy and is superior for surveillance. Advanced imaging techniques like narrow-band imaging and autofluorescence have potential but no method is clearly better than chromoendoscopy currently. The goal is optimizing endoscopic detection of dysplasia to reduce colorectal cancer risk in IBD patients.

1. Endoscopy in patients with IBD European School of Oncology Rome, Italy Dr James East Consultant Gastroenterologist, John Radcliffe Hospital 12 April 2011

3. Current international guidelines ECCO 2008 BSG 2010 (and NICE) AGA 2010 ACG 2010 Screening 8-10 yrs 10 Years Max 8 years 8-10 years Surveillance Extensive 2 yrly to 20yr then annually Left sided 2yrly starting at 15 yrs PSC: 1yrly By risk: Low 5 yrs Intermediate 3 yrs High 1yrs 1-3 years More often at high risk e.g. PSC 1-2 years Chromo Superior to WLE Recommended Special cases Not yet Biopsies 33+ if no chromo 33+ if no chromo 33+ 33+

4. Current international guidelines ECCO 2008 BSG 2010 (and NICE) AGA 2010 ACG 2010 Screening 8-10 yrs 10 Years Max 8 years 8-10 years Surveillance Extensive 2 yrly to 20yr then annually Left sided 2yrly starting at 15 yrs PSC: 1yrly By risk: Low 5 yrs Intermediate 3 yrs High 1yrs 1-3 years More often at high risk e.g. PSC 1-2 years Chromo Superior to WLE Recommended Special cases Not yet Biopsies 33+ if no chromo 33+ if no chromo 33+ 33+

5. Current international guidelines ECCO 2008 BSG 2010 (and NICE) AGA 2010 ACG 2010 Screening 8-10 yrs 10 Years Max 8 years 8-10 years Surveillance Extensive 2 yrly to 20yr then annually Left sided 2yrly starting at 15 yrs PSC: 1yrly By risk: Low 5 yrs Intermediate 3 yrs High 1yrs 1-3 years More often at high risk e.g. PSC 1-2 years Chromo Superior to WLE Recommended Special cases Not yet Biopsies 33+ if no chromo 33+ if no chromo 33+ 33+

7. When to screen IBD – BSG 2010

11. Standard white light exam

14. Standard white light exam R 2 =0.12, P=0.0066 Toruner M et al. Inflamm Bowel Dis 2005; 11 :428-34

16. Biopsy protocol R 2 =0.02, P>0.05 Toruner M et al. Inflamm Bowel Dis 2005; 11 :428-34

18. Chromoendoscopy Study White Light Chromoscopy Marion 2008 9/102 (8.8%) 17/102 (16.7%) Kiesslich 2007 4/73 (5.5%) 13/84 (15.5%) Hurlstone 2005 24/350 (6.9%) 69/350 (19.7%) Rutter 2004 2/100 (2%) 7/100 (7%) Kiesslich 2003 6/81 (7.4%) 11/80 (13.8%) SUMMARY 6.4% (45/706) 95% CI 4.6-8.2 16.3% (117/716) 95% CI 13.6-19.1

19. Chromoendoscopy

20. Chromoendoscopy

21. Chromoendoscopy

22. SURFACE guidelines for chromoendoscopy in ulcerative colitis (1) S trict patient selection (2) U nmask the mucosal surface =good bowel prep (3) R educe peristaltic waves =antispasmodic (4) F ull length staining of the colon (pan-chromoendoscopy) (5) A ugmented detection with dyes (6) C rypt architecture analysis (7) E ndoscopic targeted biopsies =not random Kiesslich R et al. Gut 2004; 53 :165-76

25. Narrow band imaging

26. Narrow band imaging

28. Autofluorescence imaging

29. Autofluorescence imaging

30. Autofluorescence imaging

31. Multimodal imaging (ETMI)

32. Confocal endomicroscopy Kiesslich R et al. Gastroenterology 2007; 132 :874-882