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Dear Sir,

We read with interest the commendable study by Dr Basseri1 and colleagues that focuses on the risk of developing Colorectal Cancer (CRC) in patients with Crohn's Colitis (CC). They analyzed results of screening and endoscopic surveillance in 411 patients followed from 1992 to 2009 at their institution.

The study faces a yet unsolved problem and we would be pleased to suggest some observations born from a recent published clinical experience.2 Literature shows that screening and endoscopic surveillance can be helpful in finding an early stage of CRC in patients with CC, but the efficacy in improving CRC related survival for this setting of patients is not demonstrated. This is because studies include small and heterogeneous series of patients, very often with selection bias, resulting in a low statistical evidence. It is a problem of difficult solution due to the small number of patients analyzed, that does not spare even this study.

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