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While it is generally agreed that screening for colon cancer is a rational strategy in chronic colitis of ulcerative colitis or Crohn’s disease, there remains some debate over the approach to managing outcomes of dysplasia surveillance colonoscopy. While some have advocated for colectomy for low grade dysplasia,1–3 others have argued for more surveillance;4 while some have argued for polypectomy for adenoma-like masses (ALMs)5 others have shown the potential for disasterous outcomes if polypectomy is pursued where rigorous follow-up will not be sustained.6 However, there has been less discussion about the technical approach to dysplasia surveillance. In survey studies in the US and UK it was shown that surveillance colonoscopy frequency and biopsy protocols have varied widely.7 8 One study suggested that at least 33 biopsies were required to maximise dysplasia discovery,9 but this has never been revisited. To counter the problem of time and expense incurred with 30+ biopsies chromoendoscopy emerged as a means to target biopsies and otherwise minimise random multiple biopsies.10 11 In this issue of Gut, Lutgens et al (see page 1246) address the very basic question of timing the initiation of dysplasia surveillance.12 Elsewhere, it has been identified that colon cancers may occur before 8 years of disease.13 14 However, in a countrywide assessment Lutgens et al have systematically attempted to discern how often cancers are missed if the starting points given in current surveillance guidelines are adhered to. In the British guidelines it is suggested that surveillance colonoscopy should be initiated at 8 years in extensive colitis and 15 years in left-sided colitis.15 The authors adequately discuss that this recommendation was based mostly on expert opinion rather than on firm data. For the most part, the 8 year starting point for extensive …
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