About Prof. Ran Zhihua
Prof. Ran Zhihua is a distinguished gastroenterologist at Renji Hospital, Shanghai Jiao Tong University School of Medicine — one of China's foremost centres for inflammatory bowel disease, gastrointestinal oncology, and advanced endoscopy. He specialises in inflammatory bowel disease, colorectal cancer screening, and advanced endoscopic procedures, and leads national clinical guidelines for IBD management in China. His research programme has advanced the understanding of IBD pathogenesis, developed novel biomarkers for colorectal cancer early detection, and pioneered the application of confocal laser endomicroscopy and endoscopic ultrasound in the precision diagnosis of gastrointestinal disease. His clinical philosophy holds that in IBD, the goal of management is not simply symptom control — it is mucosal healing, sustained remission, and systematic cancer surveillance: because the patient who achieves deep remission today is the patient whose colorectal cancer risk is lowest tomorrow.
Case Overview
Mr. Chen (pseudonym), a 44-year-old man, had been diagnosed with ileocolonic Crohn's disease nine years earlier and had been managed with a combination of immunomodulator therapy and intermittent corticosteroids. Over the preceding six months he had experienced worsening abdominal pain, increased stool frequency, and weight loss of 4 kg — suggesting active disease despite his current regimen. He was also increasingly concerned about his colorectal cancer risk, having read that longstanding IBD significantly elevated this risk and having had no formal surveillance endoscopy in four years. He sought Prof. Ran Zhihua at Renji Hospital. Ileocolonoscopy with high-definition white-light and confocal laser endomicroscopy (CLE) was performed: active mucosal inflammation was confirmed in the transverse and descending colon, and CLE identified a 12 mm flat lesion in the sigmoid colon with endomicroscopic features highly suspicious for low-grade dysplasia — a lesion that had not been visible on standard white-light endoscopy. Targeted biopsies confirmed low-grade dysplasia. Endoscopic submucosal dissection (ESD) achieved en bloc resection with clear margins; no surgical intervention was required. Concurrently, Prof. Ran's team optimised Mr. Chen's IBD regimen — transitioning to biologic therapy with a TNF-α inhibitor — and achieved mucosal healing confirmed at twelve-week follow-up endoscopy. Mr. Chen reflected: "I had been living with Crohn's for nearly a decade and had never had a proper cancer check. Prof. Ran's team found something that would not have been seen with a standard scope, and they dealt with it before it became a serious problem. I am enormously grateful."
Diagnostic Workup
Ileocolonoscopy with high-definition white-light imaging assessed the extent and severity of mucosal inflammation, characterised the distribution of Crohn's disease activity, and provided the platform for advanced imaging. Confocal laser endomicroscopy (CLE) — a real-time in vivo microscopy technique that provides cellular-level imaging of the mucosal surface during endoscopy — was applied systematically to the colon, identifying the 12 mm flat sigmoid lesion with endomicroscopic features of crypt architectural distortion and cellular atypia consistent with dysplasia. Targeted biopsies of the CLE-identified lesion confirmed low-grade dysplasia on histopathology. Endoscopic ultrasound assessed the depth of the dysplastic lesion and confirmed the absence of submucosal invasion, establishing eligibility for endoscopic rather than surgical resection. Faecal calprotectin and C-reactive protein quantified systemic and mucosal inflammatory activity. MRI enterography characterised the small bowel component of Crohn's disease and excluded penetrating complications. Multidisciplinary review — gastroenterology, colorectal surgery, and pathology — confirmed the endoscopic resection strategy and the plan for IBD regimen optimisation.
Prof. Ran's pre-procedure assessment: Longstanding colonic Crohn's disease carries a significantly elevated colorectal cancer risk — a risk that is directly related to the duration and extent of colonic inflammation and the adequacy of surveillance. This patient has had active colonic disease for nine years and has not had surveillance endoscopy for four. The standard white-light examination is our starting point, but in a patient with this risk profile, CLE is the tool that gives us cellular-level resolution in real time. If there is dysplasia here, we need to find it before it progresses. The IBD regimen also needs to be addressed: active inflammation is itself a cancer risk factor, and achieving mucosal healing is as important as the surveillance endoscopy.
Treatment Strategy and Course
Diagnosis: Active Ileocolonic Crohn's Disease with Suboptimal Disease Control, and Low-Grade Dysplasia of the Sigmoid Colon Identified on Confocal Laser Endomicroscopy Surveillance in a 44-year-old patient with 9-year IBD history.
Treatment principle: simultaneous management of two interconnected problems — endoscopic resection of the dysplastic lesion to eliminate the cancer precursor, and IBD regimen optimisation to achieve mucosal healing and reduce ongoing colorectal cancer risk.
- Endoscopic submucosal dissection (ESD) of sigmoid dysplastic lesion: Submucosal injection to lift the lesion; circumferential mucosal incision; submucosal dissection to achieve en bloc resection; specimen retrieved intact (12 mm); histopathology confirmed low-grade dysplasia with clear lateral and deep margins; no perforation or significant bleeding; patient discharged the following day
- IBD regimen optimisation: Immunomodulator therapy discontinued; biologic therapy initiated with a TNF-α inhibitor (adalimumab); induction dosing completed; corticosteroid bridge used during induction and tapered over eight weeks
- Twelve-week follow-up endoscopy: Mucosal healing confirmed in the transverse and descending colon; Mayo endoscopic subscore 0; faecal calprotectin normalised; CRP within normal range; ESD resection site healed with no residual or recurrent dysplasia
- Surveillance and maintenance plan: Annual surveillance colonoscopy with CLE scheduled; biologic therapy continued with therapeutic drug monitoring; IBD clinical activity and biomarker monitoring at three-monthly intervals; colorectal cancer risk stratification updated to reflect achieved mucosal healing
Prof. Ran's clinical reflection: The CLE finding in this case is the result that changes the patient's trajectory. A 12 mm flat dysplastic lesion in a patient with longstanding colonic Crohn's disease, invisible on white-light endoscopy, resected endoscopically with clear margins — that is the outcome that surveillance is designed to achieve. The IBD optimisation is equally important: mucosal healing is not just a clinical target, it is a cancer prevention strategy. A patient in deep remission on effective biologic therapy has a fundamentally different colorectal cancer risk profile from a patient with ongoing active inflammation. Both interventions together give Mr. Chen the best possible long-term outcome.
Expert Commentary — Prof. Ran Zhihua
1. Colorectal Cancer Risk in IBD: The Case for Systematic Surveillance and Mucosal Healing as Cancer Prevention
Patients with longstanding colonic inflammatory bowel disease — both ulcerative colitis and Crohn's disease with colonic involvement — face a significantly elevated risk of colorectal cancer compared with the general population. The magnitude of this risk is determined by disease duration, extent of colonic involvement, severity of mucosal inflammation, and the presence of primary sclerosing cholangitis. The biological mechanism is well established: chronic mucosal inflammation drives cycles of epithelial damage and repair, creating a mutagenic environment in which dysplasia — the precursor to colorectal cancer — can develop. The clinical implication is twofold. First, systematic endoscopic surveillance is essential: dysplasia in IBD is frequently flat, multifocal, and invisible to standard white-light endoscopy, requiring advanced imaging techniques for reliable detection. Second, achieving and maintaining mucosal healing through effective medical therapy is itself a cancer prevention strategy: the evidence that deep remission reduces colorectal cancer risk in IBD is now substantial, and it provides a compelling oncological rationale for the use of biologic therapy in patients with active colonic disease.
2. Advanced Endoscopic Imaging in IBD Surveillance: Confocal Laser Endomicroscopy and the Precision Detection of Dysplasia
Confocal laser endomicroscopy (CLE) is a real-time in vivo microscopy technique that provides cellular-level imaging of the gastrointestinal mucosa during endoscopy, without the need for tissue biopsy. By delivering a low-power laser through the endoscope tip and detecting the fluorescence signal from topically or intravenously administered contrast agents, CLE generates images at a magnification of up to 1000× — sufficient to visualise individual crypts, goblet cells, and vascular architecture in real time. In the context of IBD surveillance, CLE enables targeted biopsy of lesions identified by endomicroscopic features of dysplasia, substantially increasing the diagnostic yield compared with random biopsy protocols. Prof. Ran Zhihua's team has been at the forefront of CLE application in China, developing and validating endomicroscopic criteria for dysplasia detection in IBD and demonstrating that CLE-guided targeted biopsy detects significantly more dysplastic lesions per procedure than standard white-light endoscopy with random biopsy. The clinical impact is direct: earlier detection of dysplasia, more frequent eligibility for endoscopic rather than surgical resection, and improved long-term outcomes for patients at elevated colorectal cancer risk.
3. Biologic Therapy in Crohn's Disease: Achieving Mucosal Healing and Redefining Treatment Targets
The treatment paradigm for Crohn's disease has been transformed by the availability of biologic therapies — TNF-α inhibitors, integrin antagonists, and IL-12/23 inhibitors — that target specific inflammatory pathways and are capable of inducing and maintaining mucosal healing in a proportion of patients who do not respond adequately to conventional immunomodulator therapy. The shift from symptom-based to endoscopic treatment targets — from clinical remission to mucosal healing, and increasingly to histological remission and transmural healing — reflects the recognition that symptom control and mucosal healing are not equivalent outcomes, and that mucosal healing is associated with substantially better long-term prognosis: lower rates of hospitalisation, surgery, and — as discussed above — colorectal cancer. Prof. Ran Zhihua's team has contributed to the national IBD management guidelines that define these treatment targets for Chinese clinical practice, and has participated in multicentre studies evaluating the efficacy and safety of biologic therapies in Chinese IBD populations. The practical framework for biologic therapy selection in Crohn's disease requires consideration of disease phenotype, prior treatment history, comorbidities, and — increasingly — therapeutic drug monitoring to optimise dosing and prevent loss of response.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mr. Chen and his family throughout the diagnostic, endoscopic, and treatment pathway at Renji Hospital, Shanghai Jiao Tong University, including: priority consultation coordination with Prof. Ran Zhihua's gastroenterology team; bilingual interpretation across all gastroenterology consultations, endoscopy planning discussions, and follow-up appointments; bilingual explanation of the IBD disease activity assessment, the CLE surveillance findings, the dysplasia diagnosis, and the endoscopic resection and IBD optimisation plan; coordination of ileocolonoscopy with CLE, endoscopic ultrasound, MRI enterography, and laboratory assessment with bilingual results communication; bilingual consent for ESD and biologic therapy initiation; post-ESD coordination including histopathology results communication and wound healing follow-up; biologic therapy initiation coordination including pre-treatment screening, induction scheduling, and therapeutic drug monitoring; and long-term surveillance coordination including annual CLE colonoscopy scheduling and IBD biomarker monitoring.
For international patients and expatriates in China living with inflammatory bowel disease — or seeking colorectal cancer screening and surveillance — Prof. Ran Zhihua's team at Renji Hospital offers access to one of China's most experienced IBD and advanced endoscopy programmes. CMCS ensures that expertise is accessible — in the patient's language, with every step coordinated and communicated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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