IBD patients must be adequately screened

Consistent surveillance of IBD patients for the development of colorectal cancer is “crucial” given that they have a two-fold higher risk of developing the disease than the general population.

This is according to Prof Marietta Iacucci, Consultant Gastroenterologist and Professor in Gastroenterology, University College Cork, who gave a presentation titled ‘Changing concepts in managing dysplasia associated with IBD’ during the Irish Society of Gastroenterology Winter Meeting 2023.

Prof Iacucci noted that IBD-related colorectal cancer contributes to significant mortality in this cohort of patients.

Detection of flat lesions in IBD patients is challenging, however, and requires excellent bowel prep, she emphasised, as poor bowel prep is the most common reason for hindering chromoendoscopy.

She stressed the importance of key performance indicators, always striving to maintain and improve quality, and good communication.

Technology has improved in the last decade, and dye‐based chromoendoscopy and virtual chromoendoscopy are now comparable as the latest data shows, and techniques for endoscopic removal of lesions continue to improve, Prof Iacucci reported, adding that skill and training are key.

Discussing the latest data on the use of biopsies, Prof Iacucci cited research showing that targeted and random biopsies detect similar proportions of neoplasia, but targeted biopsies appear to be more cost-effective so they are now the standard of care. “Though in high-risk patients still do random biopsies,” she added.

Prof Iacucci acknowledged the lack of standardised training in the detection of neoplasia in IBD – there is still no validated training course – but efforts are being made to improve the situation and she pointed to the latest European Society of Gastrointestinal Endoscopy guidelines in the area.

Briefly looking at the growing role of artificial intelligence in screening, Prof Iacucci said “there is a still a long road to go” in IBD, given the complexity of the disease and the organs involved.