Colorectal cancer screening if Crohn's disease or ulcerative colitis

People with inflammatory bowel disease

• Offer colonoscopic surveillance to people whose symptoms started 10 years ago and who have:
  • ulcerative colitis (but not proctitis alone) or
  • Crohn's colitis involving more than one segment of colon
• Offer a baseline colonoscopy with chromoscopy and targeted biopsy of any abnormal areas to determine the risk of developing colorectal cancer
  • Low risk
    • Left-sided ulcerative colitis (but not proctitis alone) or Crohn's colitis of a similar extent or
    • Extensive but quiescent ulcerative colitis or
    • Extensive but quiescent Crohn's colitis
  • Follow-up
    • Offer colonoscopy with chromoscopy at 5 years
      
      
  • Intermediate risk
    • Extensive ulcerative or Crohn's colitis with mild active inflammation (confirmed endoscopically or histologically) or
    • Post-inflammatory polyps or
    • Family history of colorectal cancer in a first-degree relative aged 50 or over
  • Follow-up
    • Offer colonoscopy with chromoscopy at 3 years
      
      
  • High risk
    • Extensive ulcerative or Crohn's colitis with moderate or severe active inflammation (confirmed endoscopically or histologically) or
    • Primary sclerosing cholangitis (including after liver transplant) or
    • Colonic stricture in the past 5 years or
    • Any grade of dysplasia in the past 5 years or Family history of colorectal cancer in a first-degree relative aged under 50
  • Follow-up
    • Offer colonoscopy with chromoscopy at 1 year

Notes:

• If colonoscopy is incomplete offer a repeat colonoscopy with chromoscopy. Consider whether a more experienced colonoscopist is needed
• If colonoscopy is not clinically appropriate, consider computed tomographic colonography (CTC). If CTC is not available or appropriate consider double contrast barium enema. Discuss the risks and benefits with the person and their family or carers if these techniques are being considered for ongoing surveillance
  
  
• Findings at follow-up
  • Offer the next colonoscopy with chromoscopy based on the person's risk at their last complete colonoscopy
    • Low risk - offer at 5 years
    • Intermediate risk - offer at 3 years
    • High risk - offer at 1 year

Reference

1. NICE. Colorectal cancer prevention: colonoscopic surveillance in adults with ulcerative colitis, Crohn's disease or adenomas. Clinical guideline CG118. Published March 2011, last updated September 2022