Synopsis
Apply current BSG risk assessment and colonoscopic surveillance to colonic inflammatory bowel disease, use high-quality dysplasia detection, and route visible, invisible and unresectable lesions through an IBD dysplasia multidisciplinary team.
- Offer baseline colonoscopic risk assessment around 8 years after symptom onset for colonic IBD, but do not place repeatedly confirmed isolated proctitis into an IBD surveillance programme; PSC instead triggers annual surveillance from diagnosis.
- Current BSG risk strata use annual surveillance for moderate active inflammation, dysplasia, PSC or a colonic stricture, and every 3 years for mild activity, extensive colitis or post-inflammatory polyps.
- People whose risk remains close to the general population enter population colorectal screening and receive colonoscopic risk reassessment every 10 years rather than automatic 1–3-year IBD surveillance.
Key red flags
Progressive distension with vomiting or obstipation, peritonism, severe pain or haemodynamic deterioration suggests obstruction or perforation and needs acute surgical assessment.
A new colonic stricture, mass, persistent bleeding, iron-deficiency anaemia or weight loss requires prompt cancer assessment rather than waiting for surveillance recall.
Invisible multifocal dysplasia, unresectable visible dysplasia or invasive cancer requires timely expert MDT and colorectal surgical discussion.
Investigation priorities
Inspect the entire colitis-affected colon, update disease extent and inflammatory activity and detect visible dysplasia.
Management branches
A 49-year-old has had extensive ulcerative colitis symptoms for 12 years. The last high-definition surveillance colonoscopy 20 months ago showed no dysplasia. Magnetic-resonance cholangiography now supports a new diagnosis of primary sclerosing cholangitis.
- Confirm the colitis history, prior histology, extent, preparation quality, family history and the new PSC diagnosis. Do not use the previously planned three-year interval because PSC now confers an annual-surveillance indication.
- Arrange high-definition surveillance colonoscopy now with experienced IBD surveillance practice and dye-based chromoendoscopy. Optimise current inflammation and bowel preparation without delaying for years.