Professional Statements and Societal Positions Guidelines
Practice Guidelines and Position Statements
American Society for Gastrointestinal Endoscopy and American Gastroenterological Association
In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and the American Gastroenterological Association published the SCENIC consensus statement on surveillance and management of dysplasia in individuals with inflammatory bowel disease (IBD). The statement, developed by an international multidisciplinary group representing a variety of stakeholders, incorporated systematic reviews of the literature. Table 1 summarizes relevant recommendations.
Table 1. Recommendations on Surveillance and Management of Dysplasia in Individuals With Inflammatory Bowel Disease
| Populations | Interventions | Comparators | Outcomes |
Individuals:- With average risk of colorectal cancer
| Interventions of interest are: | Comparators of interest are:- Standard white-light colonoscopy
| Relevant outcomes include:- Overall survival
- Disease-specific survival
- Test validity
- Change in disease status
|
Individuals:- With increased risk of colorectal cancer
| Interventions of interest are: | Comparators of interest are:- Standard white-light colonoscopy
| Relevant outcomes include:- Overall survival
- Disease-specific survival
- Test validity
- Change in disease status
|
Individuals:- With inflammatory bowel disease
| Interventions of interest are: | Comparators of interest are:- Standard white-light colonoscopy
| Relevant outcomes include:- Overall survival
- Disease-specific survival
- Test validity
- Change in disease status
|
Individuals:- With average risk of colorectal cancer
| Interventions of interest are: | Comparators of interest are:- Standard white-light colonoscopy
| Relevant outcomes include:- Overall survival
- Disease-specific survival
- Test validity
- Change in disease status
|
Individuals:- With increased risk of colorectal cancer
| Interventions of interest are: | Comparators of interest are:- Standard white-light colonoscopy
| Relevant outcomes include:- Overall survival
- Disease-specific survival
- Test validity
- Change in disease status
|
Individuals:- With inflammatory bowel disease
| Interventions of interest are: | Comparators of interest are:- Standard white-light colonoscopy
| Relevant outcomes include:- Overall survival
- Disease-specific survival
- Test validity
- Change in disease status
|
| Recommendation | LOA | SOR | QOE |
| "When performing surveillance with white-light colonoscopy, high definition is recommended rather than standard definition." | 80% | Strong | Low |
| "When performing surveillance with standard-definition colonoscopy, chromoendoscopy is recommended rather than white-light colonoscopy." | 85% | Strong | Moderate |
| "When performing surveillance with high-definition colonoscopy, chromoendoscopy is suggested rather than white-light colonoscopy." | 84% | Conditional | Low |
LOA: level of agreement; QOE: quality of evidence; SOR: strength of recommendation.
Panelists did not reach consensus on the use of chromoendoscopy in random biopsies of individuals with IBD undergoing surveillance.
Commentaries in two (2) gastroenterology journals questioned whether the SCENIC guidelines would be accepted as the standard of care in IBD surveillance. Both commentaries noted that the guidelines considered the outcome of the detection of dysplasia and not disease progression or survival. Moreover, the commentators noted the lack of longitudinal data on clinical outcomes in individuals with dysplastic lesions detected using chromoendoscopy.
The ASGE (2015) issued guidelines on endoscopy in the diagnosis and treatment of IBD, which made the following recommendations about chromoendoscopy: "Chromoendoscopy with pancolonic dye spraying and targeted biopsies is sufficient for surveillance in inflammatory bowel disease; consider 2 biopsies from each colon segment for histologic staging."
The ASGE (2015) also published a systematic review and meta-analysis assessing narrow-band imaging, i-SCAN, and Fujinon Intelligent Color Enhancement for predicting adenomatous polyp histology of small or diminutive colorectal polyps to determine whether they have met previously established criteria or thresholds to incorporate into clinical practice. The ASGE assessment confirmed that:
"....The thresholds have been met for narrow-band imaging with endoscopists who are experts in using these advanced imaging technologies and when assessments are made with high confidence. The ASGE Technology Committee endorsed the use of NBI for both the 'diagnose-and-leave' strategy for diminutive (5 mm) rectosigmoid hyperplastic polyps and the 'resect-and-discard' strategy for diminutive (5 mm) adenomatous polyps."
The report addressed the "trepidation" of individuals, endoscopists, and pathologists with the "diagnose-and-leave" strategy, indicating there are challenges for implementation for the use of these strategies in clinical practice.
U.S. Multi-Society Task Force on Colorectal Cancer
In 2020, the Multi-Society Task Force issued guidelines on the endoscopic removal of colorectal lesions. Regarding lesion assessment and description, the Task Force suggested "proficiency in the use of electronic- (e.g., NBI, i-SCAN, and Fuji Intelligent Chromoendoscopy, or blue light imaging) or dye (chromoendoscopy)-based image-enhanced endoscopy techniques to apply optical diagnosis classifications for colorectal lesion histology [conditional recommendation, moderate-quality evidence)." The Task Force also suggested "careful examination of the post-mucosectomy scar site using enhanced imaging, such as dye-based (chromoendoscopy) or electronic-based methods, as well as obtaining targeted biopsies of the site. Post-resection scar sites that show both normal macroscopic and microscopic (biopsy) findings have the highest predictive value for long-term eradication [conditional recommendation, moderate-quality evidence]."
In 2012, the Multi-Society Task Force guidelines on colonoscopy surveillance after screening and polypectomy (consensus update) stated that chromoendoscopy and narrow-band imaging might enable endoscopists to accurately determine if lesions are neoplastic and if there is a need to remove them and send specimens to pathology. The guidelines noted that these technologies currently do not have an impact on surveillance intervals.
