Dr Rubin explains key points from his presentation at AIBD 2022 on risks of colon cancer among patients with inflammatory bowel disease and how to best monitor for dysplasia and mitigate risks.

David Rubin, MD, is the Joseph B Kirsner Professor In Medicine, chief of Gastroenterology, Hepatology and Nutrition, and director of the Digestive Diseases Center at the University of Chicago School of Medicine.

TRANSCRIPT:

Hi, it's David Rubin from the University of Chicago. I'm at the Advances in IBD Meeting 2022 in Orlando, Florida.

Today, I delivered a keynote on managing dysplasia in patients with inflammatory bowel disease. The predominant focus of my presentation was on ulcerative colitis patients, where it's been long established that long duration of disease and extensive colitis are risk factors for the development of either precancerous dysplasia or colon cancer. The risks have been well-defined over the years and have evolved a bit, and I highlighted these in my presentation and then spoke about how we are working to improve our ability to prevent cancer.

Overall, although the cancer risk in colitis is increased compared to the general population of the same age, it is not as high as it was once thought to be, and we've attributed this to effective secondary prevention, which is surveillance colonoscopies, as well as likely effective primary prevention, meaning that we're doing a better job controlling inflammation. Recognizing that inflammation is likely the primary driver of precancerous and cancerous changes, our improved medical therapies and endpoints of management have probably driven down the overall risk of cancer. So the emphasis is that we should be treating our patients to achieve endoscopic improvement and probably histologic improvement as well, although that's still evolving. And we should continue to perform surveillance colonoscopy.

I highlighted the important role of knowing that as our technology has evolved, including high-definition scopes and electronic chromoendoscopy, like narrow band imaging or i-scan or autofluorescence, we've been able to detect more dysplasia. And by seeing more dysplasia, we can perform effective surveillance, remove lesions that are visible, or even follow some patients carefully. It has enabled us to consider that we might not need to do surgery in everyone where dysplasia is identified, and in fact, we can perform active surveillance after we've removed dysplasia in individual patients.

I highlighted the evolving guidelines from the ACG, the AGA, and our European colleagues in echo to emphasize a few takeaway points. If you're using high-definition colonoscopes, you can perform a careful exam and do targeted biopsies with removal of suspicious lesions. If you're using standard definition scopes, it is still recommended that you use dye spray chromoendoscopy, where it has definitely been demonstrated that this enables you to find more neoplasia. But again, with high-definition scopes, with or without electronic chromoendoscopy or dye spray, the white light in that exam when the patient's in remission is sufficient to find most neoplasia.

I also emphasize the evolving nomenclature and ways to describe what we find, including the macroscopic lesions of either raised or depressed lesions, using some of the standard Paris classification systems, as well as what I call near microscopic descriptions, which is recognizing pit patterns, which is something that not everyone is comfortable doing, but which can definitely allow you to perform essentially in vivo pathology so you know what you should target, what you should remove, or when you're not sure, what you should do biopsies.

We also spent a little time focused on patients who are of particular high risk, those patients who have continuous inflammation every time you look, and people who have concomitant PSC, where the risk of colorectal cancer is so high that it's recommended that you perform annual surveillance exams. For the patients who don't have PSC and who have minimal other risks, we are now lengthening our surveillance intervals. And I reviewed the evidence and the recommendations from the AGA that suggest that we might go as long as 5 years for some low-risk patients between exams.

Overall, I found that this was a helpful summary for our colleagues, but also, during the session, we had wonderful presentations by a colorectal surgeon and by other colleagues to focus on different approaches and understanding the overall risks among our patients. I think that we've made some great progress in colon cancer prevention in colitis, and I hope that you found this summary helpful.