One of the most feared complications of inflammatory bowel disease (IBD)-associated colitis is colorectal cancer. When considering the substantial increase in the prevalence of IBD without any anticipated decline, coupled with decreasing colectomy rates for dysplasia and expanding medical options for effectively controlling inflammation, it is predicted that the pool of people living with-and aging with-colonic IBD who are recommended to undergo lifelong colonoscopic surveillance for colorectal neoplasia will strain existing resources and challenge the sustainability of current guideline-based surveillance recommendations. At the same time, we are missing the opportunity for early detection in a group that is overlooked as high-risk, as a substantial proportion of colorectal cancers are being diagnosed in individuals with colonic IBD who have disease duration shorter than when guidelines recommend surveillance initiation. Here, we reappraise 1) inflammation as a dynamic risk factor that considers patients' cumulative course; 2) time of screening initiation that is not based primarily on absolute disease duration; and 3) surveillance intervals as an iterative determination based on individual patient factors and consecutive colonoscopic findings. This Viewpoint supports a paradigm shift that will ideally result in a more effective and higher value colorectal cancer prevention approach in IBD.

中文翻译：

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重新评估炎症性肠病相关肿瘤的危险因素：IBD结肠镜检查的意义。

大肠癌是与炎症性肠病（IBD）相关的结肠炎最令人担忧的并发症之一。考虑到IBD的患病率大幅上升而未见任何预期的下降，再加上不典型增生的结肠切除率降低和有效控制炎症的医疗选择范围的扩大，预计患有结肠炎IBD和衰老的结肠炎IBD的人群建议对结肠直肠肿瘤进行终身结肠镜检查，这将使现有资源紧张，并挑战当前基于指南的监测建议的可持续性。同时，我们在一个被视为高风险，因为在结肠IBD患者中诊断出大肠癌的比例很高，其病程比指南建议开始监测的时间短。在此，我们重新评估：1）炎症是考虑患者累积病程的动态危险因素；2）开始筛查的时间主要不是基于绝对疾病的持续时间；3）监视间隔作为基于各个患者因素和连续结肠镜检查结果的反复确定。该观点支持范例转变，理想情况下将导致IBD中更有效，价值更高的结肠直肠癌预防方法。2）开始筛查的时间主要不是基于绝对疾病的持续时间；3）监视间隔作为基于各个患者因素和连续结肠镜检查结果的反复确定。该观点支持范例转变，理想情况下将导致IBD中更有效，价值更高的结肠直肠癌预防方法。2）开始筛查的时间主要不是基于绝对疾病的持续时间；3）监视间隔作为基于各个患者因素和连续结肠镜检查结果的反复确定。该观点支持模式转变，理想情况下将导致IBD中更有效，价值更高的结直肠癌预防方法。