• What is the Best way to Monitor and Manage Dysplasia in Patients with IBD?

What is the Best way to Monitor and Manage Dysplasia in Patients with IBD?

The American Gastroenterological Association, along with the American Society for Gastrointestinal Endoscopy, have issued updated recommendations for the surveillance and management of dysplasia in patients with inflammatory bowel disease (IBD). 

In a commentary in the March issue of Gastroenterology, James F. Marion and Bruce E. Sands discuss the recommendations, and how gastroenterologists should best monitor and manage dysplasia in patients with inflammatory bowel diseases.

The authors explain that there have been many different recommendations on surveillance for dysplasia and how to manage it once found, leading to considerable discord and confusion.

The new recommendations were developed by an international group of experts and stakeholders in IBD surveillance, in accordance with suggested standards from the Institute of Medicine. Existing guidelines on this topic were considered, and in some cases, accepted in the new consensus statement.

Progression of dysplasia in patients with IBD and endoscopic screening strategies, including low- and high-resolution methods.

Progression of dysplasia in patients with IBD and endoscopic screening strategies, including low- and high-resolution methods.

Marion and Sands state that recommendations provide a comprehensive summary of data to guide surveillance and management strategies for patients with IBD.

Their commentary provides a history of surveillance in patients with IBD, discusses the efficacy of chromoendoscopy in detecting dysplasia, and management of patients found to have dysplasia.

The Consensus Statement addresses the optimal types of endoscopic procedures and equipment to be used, recommended practices for removal of lesions, or referral for the more invasive surgical procedure known as colectomy.

In particular, the updated recommendations reflect a shift to using chromoendoscopy for patients with IBD, to better visualize the tissue.

Marion and Sands write that “if the SCENIC recommendations are put into widespread practice, we must mobilize to track dysplasia on a much larger scale.” This could lead to new and helpful information on the outcomes of patients with dysplasia and identify gaps in the guidelines that can be closed.

The authors explain that it is important to learn how to stratify patients based on risk, how to best manage dysplasia once it is found, and how to set appropriate screening intervals.

 

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