Diagnosis

• Offer colonic surveillance in IBD (UC and Crohns) in patients who have had symptoms > 10 yrs (baseline colonoscopy with chromoscopy (staining) and targeted biopsy of any abnormal areas to determine their risk of developing colorectal cancer)
• Consider colonoscopic surveillance for people with adenomas removed and at low risk

Investigation

IBD

• Low risk: extensive but quiescent UC or Crohns or limited extent
• Medium risk: extensive and mildly irritated UC or Crohns, OR post inflammatory polyps OR first degree relative > 50 with colorectal cancer
• High risk: extensive and moderately or severely irritated UC or Crohns, OR primary sclerosing cholangitis, OR colonic stricture, OR any grade dysplasia, OR first degree relative < 50 with colorectal cancer

Previous Adenomas

• Low risk: one or two adenomas smaller than 10 mm
• Intermediate risk: 3 or 4 adenomas < 10 mm or 1 or 2 adenomas if one is 10 mm or larger
• High risk: 5 or more adenomas < 10 mm or 3 or more adenomas if one is 10 mm or larger

Management

• Colonic Surveillance in patients with IBD:
  • Low risk: offer colonoscopy at 5 years
  • Intermediate risk: offer colonoscopy at 3 years
  • High risk: offer colonoscopy at 1 year
• Colonic Surveillance in patients with previous adenomas:
  • Low risk: consider colonoscopy at 5 years
  • Intermediate risk: offer colonoscopy at 3 years
  • High risk: offer colonoscopy at 1 year
• If colonoscopy not appropriate consider CT colonoscopy or if not appropriate double contrast barium enema

NICE Source: CG118 Colorectal cancer prevention: colonoscopic surveillance in adults with ulcerative colitis, Crohn’s disease or adenomas. Summary compiled by Dr D P Sheppard MBBS.