Annual CRC surveillance in IBD with PSC

What is known

• Patients with concomitant PSC are at additionally increased CRC risk and should undergo annual surveillance starting immediately after diagnosis. ¹
• Current guidelines recommend annual CRC surveillance for all patients with IBD and PSC. ²
• UC patients with PSC have greater risk of colorectal dysplasia or cancer than UC alone, so annual surveillance colonoscopies are recommended. ³
• Some reviews recommend colonoscopy at the time of PSC diagnosis and thereafter at 1-2 year intervals. ⁴

What is unknown / caveats

• Some sources specify strictly annual surveillance ^1–3 while others state 1-2 year intervals from PSC diagnosis ⁴
• One cohort questioned whether PSC duration/severity is associated with neoplastic risk in the colon ⁵
• These recommendations are based on limited evidence and largely expert opinion rather than controlled trials ^1,6
• Real-world practice is inconsistent, with clinicians reporting a range of intervals ⁷
• Sources differ on whether the interval is strictly annual or 1-2 years, though all agree surveillance should intensify and begin at PSC diagnosis.

References

1. Wijnands AM, Mahmoud R, Lutgens MWMD, Oldenburg B. Surveillance and management of colorectal dysplasia and cancer in inflammatory bowel disease: Current practice and future perspectives. Eur J Intern Med. 2021. PMID: 34481721.

2. Imam MH, Thackeray EW, Lindor KD. Colonic neoplasia in young patients with inflammatory bowel disease and primary sclerosing cholangitis. Colorectal Dis. 2013. PMID: 22712545.

3. Braden B, Halliday J, Aryasingha S, Sharifi Y, Checchin D, Warren BF, Kitiyakara T, Travis SP, Chapman RW. Risk for colorectal neoplasia in patients with colonic Crohn's disease and concomitant primary sclerosing cholangitis. Clin Gastroenterol Hepatol. 2012;10(3):303-8. PMID: 22037429.

4. Razumilava N, Gores GJ, Lindor KD. Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology. 2011. PMID: 21793028.

5. Hatami B, Pasharavesh L, Sharifian A, Zali MR. Concurrent inflammatory bowel disease and primary sclerosing cholangitis: a review of pre- and post-transplant outcomes and treatment options. Gastroenterol Hepatol Bed Bench. 2023;16:259-269. PMID: 37767322.

6. Itzkowitz Steven H, Harpaz N. Diagnosis and management of dysplasia in patients with inflammatory bowel diseases. Gastroenterology. 2004;126:1634-48. PMID: 15168373.

7. Jagt JZ, van Schie DA, Benninga MA, van Rheenen PF, de Boer NKH, de Meij TGJ. Endoscopic Surveillance for Colorectal Cancer in Pediatric Ulcerative Colitis: A Survey Among Dutch Pediatric Gastroenterologists. JPGN Rep. 2023. PMID: 37600610.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.