Colorectal screening: if ulcerative colitis or Crohn's

People with inflammatory bowel disease

• Offer colonoscopic surveillance to people whose symptoms started 10 years ago and who have:
  • ulcerative colitis (but not proctitis alone) or
  • Crohn's colitis involving more than one segment of colon
• Offer a baseline colonoscopy with chromoscopy and targeted biopsy of any abnormal areas to determine the risk of developing colorectal cancer
  • Low risk
    • Left-sided ulcerative colitis (but not proctitis alone) or Crohn's colitis of a similar extent or
    • Extensive but quiescent ulcerative colitis or
    • Extensive but quiescent Crohn's colitis
  • Follow-up
    • Offer colonoscopy with chromoscopy at 5 years
      
      
  • Intermediate risk
    • Extensive ulcerative or Crohn's colitis with mild active inflammation (confirmed endoscopically or histologically) or
    • Post-inflammatory polyps or
    • Family history of colorectal cancer in a first-degree relative aged 50 or over
  • Follow-up
    • Offer colonoscopy with chromoscopy at 3 years
      
      
  • High risk
    • Extensive ulcerative or Crohn's colitis with moderate or severe active inflammation (confirmed endoscopically or histologically) or
    • Primary sclerosing cholangitis (including after liver transplant) or
    • Colonic stricture in the past 5 years or
    • Any grade of dysplasia in the past 5 years or Family history of colorectal cancer in a first-degree relative aged under 50
  • Follow-up
    • Offer colonoscopy with chromoscopy at 1 year

Notes:

• If colonoscopy is incomplete offer a repeat colonoscopy with chromoscopy. Consider whether a more experienced colonoscopist is needed
• Findings at follow-up
  • Offer the next colonoscopy with chromoscopy based on the person's risk at their last complete colonoscopy
    • Low risk - offer at 5 years
    • Intermediate risk - offer at 3 years
    • High risk - offer at 1 year
      
      
      
      
      
      
      
      
      
      

Reference:

• 1) NICE (March 2011). Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas