Dysplasia in inflammatory bowel disease

The risk of neoplasia in ulcerative colitis and Crohns colitis increases with both the duration and the extent of disease. In patients with extensive or pancolitis, the cancer risk increases dramatically 8 to 10 years after the first onset of disease. Childhood onset of colitis and primary sclerosing cholangitis further increase the risk of developing colorectal carcinoma. The performance of surveillance endoscopy to identify dysplastic precursor lesions via endoscopic biopsy specimens has become the main management strategy to combat this risk. Biopsies should be classified as negative for dysplasia, indefinite for dysplasia, low-grade dysplasia, or high-grade dysplasia according to standard criteria. A prophylactic colectomy is the procedure of choice when high-grade dysplasia or low-grade dysplasia associated with a lesion or mass is present. Some centers also recommend a colectomy for the presence of low-grade dysplasia in flat mucosa. Given these management recommendations, care should be taken not to overcall reactive epithelial changes in the face of active colitis. All diagnoses of dysplasia should be confirmed, preferably by a pathologist experienced in interpreting gastrointestinal biopsies.