Clin Gastroenterol Hepatol. 2024 Jul;22(7):1535-1538.e2. doi: 10.1016/j.cgh.2023.12.007.Epub 2023 Dec 18.

Sanjay K Murthy ¹, Charles N Bernstein ², Geoffrey C Nguyen ³, Vipul Jairath ⁴, Robert Riddell ⁵, Dean Fergusson ⁶; Canadian IBD Research Consortium

Collaborators

Canadian IBD Research Consortium: 

James Conner ⁵, Tim Ramsay ⁷, Jane M Castelli ⁸, Faria Ahmed ⁹, Neeraj Narula ¹⁰, Talat Bessissow ¹¹, Brian Bressler ¹², Mark Borgaonkar ¹³, Jennifer Jones ¹⁴, Dustin Loomes ¹⁵, Frank Hoentjen ¹⁶, Daniel C Baumgart ¹⁷, Petros Zezos ¹⁸, Terrance Moyana ¹⁹, Jennifer Ramsay ²⁰

Author information

¹Department of Medicine and, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Inflammatory Bowel Disease Centre, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada. Electronic address: smurthy@toh.ca.

²Division of Gastroenterology, Department of Internal Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.

³Centre for Inflammatory Bowel Disease, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada.

⁴Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; London Health Sciences Centre, University Hospital, London, Ontario, Canada.

⁵Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

⁶Department of Medicine and, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.

⁷Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

⁸Department of Medicine (Division of Gastroenterology), McMaster University, Hamilton, Ontario, Canada.

⁹Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.

¹⁰Department of Medicine (Division of Gastroenterology), McMaster University, Hamilton, Ontario, Canada; Farncombe Family Digestive Health Research Institute, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

¹¹Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.

¹²Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.

¹³Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada.

¹⁴Departments of Medicine & Clinical Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.

¹⁵Centre for Inflammatory Bowel Disease, Mount Sinai Hospital, Toronto, Ontario, Canada.

¹⁶Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

¹⁷Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany.

¹⁸Division of Gastroenterology, Department of Internal Medicine, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine University, Thunder Bay, Ontario, Canada.

¹⁹Department of Pathology, University of Ottawa, Ottawa, ON, Canada.

²⁰Department of Pathology and Molecular Medicine, McMaster, McMaster University, Hamilton, ON, Canada; Department of Anatomic Pathology, Hamilton Regional Laboratory Medicine Program (HRLMP), Hamilton Health Sciences, Hamilton, ON, Canada.

Abstract

Persons with inflammatory bowel disease (IBD) affecting the colorectum (cIBD) have a 1.5- to 2-fold higher risk of developing colorectal cancer (CRC) relative to age- and sex-matched members of the general population.¹ Intensive surveillance colonoscopy is recommended in this population to detect and treat early neoplastic lesions before they evolve to incurable cancers.² Some societies advocate for widespread non-targeted ("random") biopsies throughout the colorectum to screen for "invisible" neoplastic lesions, in addition to targeted biopsies and/or resection of visible lesions.² Despite the theoretical value of non-targeted biopsies in this setting, there are no high-quality, controlled data to support this practice. In addition to adding significant time and costs to colonoscopy screening, extensive biopsy sampling may also increase the risk of colorectal bleeding and bowel perforation, particularly in elderly patients and those receiving anticoagulant/antiplatelet therapies. With the widespread adoption of disease-modifying biologic and small molecule therapies,³ mucosal healing as a treatment end point,⁴ high-definition endoscopes,⁵ and endoscopy quality standards,⁶ as well as reports of very low neoplasia yield for non-targeted biopsies (0.1%-0.2% of biopsies),⁷ many experts have started to question the value of non-targeted biopsies as an adjunct for neoplasia surveillance in persons with cIBD.⁸ However, a recent large French cohort study reported that non-targeted biopsies still identify up to 20% of all neoplastic foci in persons with cIBD,⁹ albeit primarily in individuals with other major CRC risk factors.