Colonic Dysplasia/Cancer Surveillance

Objective: Early detection of colon cancer/dysplasia

Patient population: Patients with a known diagnosis of IBD whose disease is in endoscopic remission. Active inflammation precludes a detailed assessment of colonic dysplasia.

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The applicability of some suggested recommendations in these guidelines may be impacted by the IBD practitioners’ access to recommended resources (colonic dye spray / virtual chromoendoscopy). 


This care protocol aims to provide IBD providers guidelines for colonic dysplasia/cancer surveillance based on patients’ risk.  

IBD Provider:

Patient Populations


Ulcerative colitis extending beyond the rectum or Crohn’s colitis involving 1/3 or more of the colon, has had disease for at least 8 years

Surveillance colonoscopy recommended, frequency according to risk (see Figure 1) (PACE QPI 11)

Ulcerative colitis or Crohn’s colitis (of any duration) and has coexisting primary sclerosing cholangitis (PSC)

Annual surveillance colonoscopy (PACE QPI 10)

Ulcerative colitis or Crohn’s colitis has confirmed dysplasia in flat mucosa

Early repeat colonoscopic surveillance using pancolonic dye spray or virtual chromoendoscopy (interval depending on dysplasia risk).

Consider surgical referral in very high-risk cases (i.e. high-grade dysplasia or multi-focal dysplasia) (PACE QPI 19

Ulcerative colitis or Crohn’s colitis has confirmed visible dysplasia

Continued endoscopic surveillance if confirmed complete endoscopic resection and no invasive cancer on histology (interval depending on dysplasia risk); otherwise, surgical referral

Total proctocolectomy with an ileal pouch-anal anastomosis (IPAA)

Surveillance endoscopy according to risk (see Figure 2)

IBD with a subtotal colectomy

Consider surgical referral for a completion proctectomy as an alternative to ongoing endoscopic dysplasia surveillance; otherwise, endoscopic surveillance every 1- 5 years, depending on risk factors for colorectal cancer (See Figure 1). (PACE QPI 8)

 Figure 1: Surveillance recommendations for colonoscopy

*If Available CRC-Colorectal Cancer FDR-First Degree Relative PSC-Primary sclerosing Cholangitis

Figure 2: Surveillance recommendations post-colectomy


Bisschops R, East JE, Hassan C, et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy. 12 2019;51(12):1155-1179.

Cairns SR et al. Guidelines for colorectal cancer screening and surveillance in moderate and high-risk groups (update from 2002). Gut 2010;59:666–89.

Feakins RM.  Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines. Journal of Clinical Pathology 2013; 66(12):1005-26.

Lamb et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106.

Magro F, Gionchetti P, Eliakim R, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. Jun 2017;11(6):649-670. doi:10.1093/ecco-jcc/jjx008

Murthy SK, Feuerstein JD, Nguyen GC, Velayos FS. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology. 09 2021;161(3):1043-1051.e4.

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