In this episode of the BSG Top to Bottom podcast, Prof James East and Prof Pradeep Bhandari dive into the endoscopic aspects of the new BSG IBD Surveillance Guidelines. Building on part one’s focus on cancer risk and surveillance rationale, this discussion explores practical essentials, from bowel preparation and patient comfort to chromoendoscopy, lesion detection, and the nuances of managing dysplasia in IBD. The conversation also highlights training, service delivery, MDT decision‑making, and the evolving roles of advanced endoscopic techniques and surgery.

• (00:00:00) - Top to Bottom: Endoscopic Surveillance
• (00:01:03) - The BSG Guidelines on IBD
• (00:02:04) - IBD bowel prep
• (00:06:01) - Colonoscopy: Comfort and Safety
• (00:09:26) - BSG 5, Virtual Chromo Endoscopy
• (00:18:24) - Invisible dysplasia
• (00:21:09) - Who should be doing IBD endoscopy?
• (00:25:06) - Diabetes and colitis 6, Neoplasia management
• (00:34:11) - Segmental resection in IBD
• (00:38:51) - Intensive surveillance for colonoscopy patients with dysplasia
• (00:41:55) - Endoscopy and cancer: concordance

Join Dr. Shahida Din, consultant gastroenterologist and Chair of the BSG IBD Section, for an in‑depth conversation with Professor James East, leading gastroenterologist, endoscopist, and co‑author of the new BSG IBD Surveillance Guidelines. They explore how cancer risk in IBD has evolved, when to start or stop surveillance, and the shift toward personalised risk assessment. The episode covers key updates on bowel prep, biopsy strategies, patient experience, and what clinicians should know to deliver high quality, patient centred surveillance.
Stay tuned for Part 2 on endoscopic techniques and dysplasia management with Professor Pradeep Bhandari

Part seven of seven: Dr Alexandra Kent, Consultant Gastroenterologist at King’s College Hospital, is joined by Professor Jimmy Limdi, Head of the IBD section at the Northern Care Alliance NHS Foundation Trust, to explore how Crohn's Disease recurrence is defined, predicted, monitored, and managed after surgery as recommended in the BSG IBD Guidelines.

Together, they discuss the continuum of post-operative recurrence from histological and endoscopic changes to clinical and surgical relapse. They highlight key patient, disease, and surgical risk factors, including smoking and aggressive disease phenotypes. The episode covers best practice for post-operative monitoring, including the role of ileocolonoscopy, Rutgeerts scoring, faecal calprotectin, intestinal ultrasound, and cross-sectional imaging.

Part six of seven: Polychronis Pavlides, Consultant Gastroenterologist at King's College Hospital in London and Fraser Cummings, Consultant Gastroenterologist in Southampton and adult IBD service lead, discuss the first line treatment of Luminal Crohn’s Disease outlined in the newly updated BSG IBD Guidelines.

They explore the importance of shared decision making and patient centred care along with practical guidance on choosing therapies, monitoring response, and aligning with STRIDE targets. This podcast also includes the challenges in comparative effectiveness and why sequencing remains complex.

Part five of seven: Krishna Shah, Gastroenterology Registrar and IBD Research Fellow at the Royal London Hospital and Dr. Kamal Patel, Consultant Gastroenterologist at St George's Hospital discuss the Advanced Therapies in Ulcerative Colitis section of the new BSG guidelines beginning with mesalazine, prednisolone and azathioprine through to thiopurines and anti-TNFs. They discuss the cost-benefit outcomes of the drug pathways advised in the BSG Guidelines including some of the potential adverse side-effects.

Part four of seven: Professor Naila Arebi, Consultant Gastroenterologist and colleague, Consultant Colorectal Surgeon, Janindra Warusavitarne, both at St Mark's National Bowel Hospital, discuss the application of the BSG IBD Guidelines to provide optimal treatment using a holistic approach and deliver the best quality of care for patients.

They talk about the important relationship between surgeons and gastroenterologists in the diagnosis and treatment of Perianal Crohn’s disease, supporting this with systematic clinical research.

Part three of seven: Trainee Gastroenterologist, Jennifer Tham, interviews, Dr. Bel Kok, Consultant Gastroenterologist at the Royal London Hospital and Honorary Senior Lecturer at Queen Mary University of London, to discuss the practical application of the latest ASUC guidelines. They explore the presenting symptoms and diagnosis of acute severe ulcerative colitis, including the use of statistical algorithms summarised in the IBD guidelines.

Given the severity and high risk profile of ASUC, rapid access to up-to-date guidance is essential to prevent delays in treatment. Jennifer and Dr. Kok also examine the updated therapies and management strategies outlined in the new guidelines.

Part two of seven: Dr. Shahida Din, Chair of our IBD Committee, and Dr. Jonathan Blackwell—both Consultant Gastroenterologists at the Edinburgh IBD Unit—are joined by Mrs. Fiona Rees, Consultant Pharmacist at University Hospitals Sussex, to explore the BSG IBD Guidelines with a focus on therapy de-escalation. Together, they discuss how best to manage patient expectations around treatment and outcomes.

They also take a detailed look at the role of Mesalazine, routes of administration, Thiopurines, anti-TNF therapies, Pulse Therapy, and the importance of continually reassessing treatment plans.