Inflammatory bowel disease (IBD) has a well-established association with the development of colorectal cancer, with both ulcerative colitis and Crohn’s disease known to increase the risk for this malignancy.
Guidelines have consistently recommended colonoscopic surveillance beginning at 8 years after the onset of IBD symptoms in order to determine the extent of disease and to establish surveillance intervals. Historically, it has been the standard recommendation while the patient has quiescent disease for four-quadrant biopsies to be performed, randomly taken every 10 cm, with additional targeted biopsies of focal mucosal lesions suspect for dysplasia.
Until recently, the identification of dysplasia in the colon was a general indication for total colectomy. However, contemporary advances in detection and endoscopic resection of focal lesions have established a new standard for best practice management, in most cases sparing patients from the morbidity of surgical colectomy.