Our newly updated guideline for colorectal surveillance for patients with IBD is now available, providing a comprehensive road map for evidence-based, expert management of the whole pathway to try and prevent or detect bowel cancer early for this higher risk patient group.

These guidelines update the BSG 2010 guidelines with a comprehensive literature search of almost 8000 papers and consensus voting leading to 73 new recommendations using the most up to date GRADE methods to maximise transparency of decision making.

Key points:

• IBD patients remain at increased risk of bowel cancer compared to the general population but this is much lower than previously, and not all patients have increased risk
• For those at risks the most important issue is attending for their colonoscopy at the correct time, and IBD surveillance services need to support patients to achieve this
• Surveillance is focussed on those at highest risk with colonoscopy every 1-3 years determined by risk factors
• A new web-tool can help clinicians make more personalised recommendations for patients using a web-based tool that considers multiple risk factors together
• Those at population risk may not need surveillance, but will be reassessed every 10 years and have population-based bowel cancer screening
• High-definition colonoscopy with chromoendoscopy (blue dye-spray) is recommended to maximise detection of pre-cancerous changes
• If pre-cancerous changes are found these can usually be removed without surgery but often need frequent on-going surveillance colonoscopy every year
• Occasionally surgery is necessary and may involve removing all or part of the bowel. Decisions about pre-cancerous changes or cancer should always be discussed at a multi-disciplinary team meeting taking into account the patient’s views
• Education of both patients and endoscopists is key to delivering a high quality, comfortable, effective IBD surveillance service

Prof James East, who chaired the Guideline Development Group (GDG), University of Oxford says:

“This comprehensive update which involved multiple IBD stakeholders in its development reflects the extensive new data and evidence from modern IBD care. While bowel cancer risk overall is lower, we need to focus our effort on those at highest risk, ensuring they get timely, high-quality colonoscopy by experienced IBD endoscopists. A good patient experience is paramount in delivering effective cancer prevention and supporting concordance with surveillance recommendations.”

Prof Morris Gordon, Guideline Development Group (GDG) co-chair, University of Central Lancashire;

“This guideline has allowed us to combine the best evidence with cutting edge research techniques to inform the experts on the guideline group. This has pushed the boundaries for international guidelines and sets a benchmark for the international community moving forward.”

Dr Shahida Din, BSG IBD Section Chair and risk lead says:

“We have co-produced a guideline with patients and clinical experts to reflect the current evidence on (large) bowel cancer in patients with inflammatory bowel disease.

Bowel cancer risk is not the same for everyone with IBD and the new recommendations will provide a more personalised approach to detecting and treating pre-cancerous cells and bowel cancer early (for patients with IBD). Treating active inflammation reduces bowel cancer risk and we would strongly encourage healthcare organisations to develop pathways, that would support patients to continue effective IBD therapies and clinical services to optimise IBD bowel cancer surveillance programmes.”

Catherine Winsor, Director of Services and Evidence at Crohn's & Colitis UK, said:

"We know that people living with Crohn's and Colitis need personalised, joined-up care and some IBD services are stretched. Having this clear set of guidelines to facilitate the early detection of cancer in people with Crohn's and Colitis is a huge step forward. Whilst we know that most people with IBD will not go on to develop colorectal cancer, the earlier changes are spotted, the more effective treatment will be. Anything that enables early detection and gives patients and clinicians a clear path is vital."

Read what the GDG section leads say:

Prof Chris Lamb, Professor of Gastroenterology (Translational & Clinical Research Institute);

“Working in partnership with patients and clinicians from across the UK we have an important up-to-date framework for care using the latest evidence, technology and expert opinion. This will help to provide shared decision-making tailored to the individual for personalised risk prediction and treatment. Developing the guidelines allowed us to identify key factors for delivering the highest quality care in the NHS, how best to train the future workforce, plus to identify where more research is needed in 2025 and beyond.”

Dr Ana Wilson, Consultant Gastroenterologist and Specialist Endoscopist;

“This Guideline, which has synthesised the latest evidence and expert opinion, represents a real step forward towards more personalised surveillance for cancer in patients with longstanding inflammatory bowel disease. The emphasis on shared decision making will hopefully empower patients and lead to better clinical outcomes.”

Prof Adrian Bateman, Consultant Histopathologist;

“These extensive guidelines include advice on the pathological assessment of biopsies from patients with inflammatory bowel disease, with particular reference to the identification of conventional and non-conventional forms of dysplasia. The potential advantage of gaining a specialist opinion when a diagnosis of inflammatory bowel disease-associated dysplasia is under consideration, is highlighted.”

Prof Marietta Iaccuci, Consultant Gastroenterologist;

“Patient-reported Experience Measures (PREMS) should be incorporated into routine IBD care to give voice to patients' perceptions of healthcare delivery processes, across communication, access to services, shared decision-making, emotional support and confidence. This will help to enhance the quality and delivery of IBD care.

Key quality performance in IBD surveillance lies in a comprehensive patient-centred approach that ensures accurate diagnosis and improved long-term patient outcomes.”

Dr Misha Kabir, Consultant Gastroenterologist;

"These comprehensive updated guidelines aim to inform patients and healthcare professionals as to who is most at risk of developing IBD-related large bowel cancer using an individualised evidence-based approach. Clinical services are encouraged to use measurable outcomes to ensure that high quality surveillance is being delivered to all patients and that action is taken promptly if pre-cancerous changes are found; all with the overall objective of cancer prevention"

Our guidelines are developed using the process outlined here and are overseen by the BSG Clinical Services and Standards Committee (CSSC). 

Our guidelines grow out of the collaborative efforts of many members and non-members, specialists and generalists and people with lived experience of the topic being covered. 

All BSG guidelines are published in BMJ Gut under an open access licence and available for free via the BSG website.