SCENIC International Consensus Statement on Surveillance and Management of Dysplasia in Inflammatory Bowel Disease

Endoscopic diagnosis and treatment of precancerous colorectal lesions in patients with inflammatory bowel disease: How does the latest SCENIC international consensus intersect with our clinical practice?

“…According to the new SCENIC consensus, the detection rate of IBD-related dysplasia by chromoendoscopy is 1.8 (95%CI: 1.2-2.6) times as that by the white light endoscopy, corresponding to an absolute increase in detection rate by 6% (95%CI: 0-9). [7] In clinical practice, we usually perform screening when IBD patients are clinically stable, and thus, they may have less active mucosal inflammation that would interfere with the endoscopic investigation. During the procedure, 0.03% indigo carmine is sprayed evenly onto the colonic mucosa along which the passage of colonoscope being withdrawn after it has been previously advanced to the ileocecal junction.…”

“…In 2015, the latest SCENIC consensus on surveillance and management of dysplasia in inflammatory bowel disease was simultaneously published in two reputed journals, the Gastroenterology and the Gastrointestinal Endoscopy. [7] Compared with the 2010 edition, the updated document throws light on the research progress in recent years and incorporates the latest understanding in this field. For example, regarding terminology, due to the significant improvement in endoscopic diagnostics, the SCENIC consensus recommends that the term 'dysplasia associated lesion or mass' (DALM) should no longer be used.…”

Patients with Endoscopically Visible Polypoid Adenomatous Lesions Within the Extent of Ulcerative Colitis Have an Increased Risk of Colorectal Cancer Despite Endoscopic Resection

“…Other studies have classed only those polyps outside the extent of histological inflammation as sporadic adenomas further adding to the confusion in terminology of these lesions 9 . The recent SCENIC guidelines suggests using the standard Paris classification for colorectal lesions along with additional descriptors of whether the lesions was within the colitic segment, circumscribed, endoscopic resectability and associated ulceration 10 . A systematic review which included 10 studies, with 376 IBD patients with resected polypoid dysplasia followed up for a mean of 54 months, reported an pooled incidence for dysplasia and CRC of 65 and 5.3 cases per 1000 patient years respectively 11 .…”

“…The recommendation of the SCENIC panel based on 9 studies reviewed (all retrospective and single arm) on the endoscopic management of polypoid dysplastic lesions during the videoendoscope era was endoscopic resection with continued surveillance 10 . One of the major criticisms of these studies was that they were mainly single arm (no comparator) and did not take into account other risk factors for cancer.…”

Getting a Low Grade for Missing High-Grade Dysplasia and Colorectal Cancer in IBD

“…Over the last decade, as newer endoscopic techniques such as chromo-, narrow-band, and highdefinition endoscopy have matured, the management of IBD-associated mucosal abnormalities, particularly LGD, has shifted toward decreasing rates of colectomy in favor of endoscopic management [3]. This trend was generally endorsed in the Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendation (SCENIC) guidelines for the management of dysplasia and carcinoma in IBD [4]. An important consideration as these newer strategies become more widespread is the rate of undetected advanced lesions (HGD and invasive carcinoma) in patients undergoing endoscopic surveillance, for which remarkably few data are available.…”