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Clin Colon Rectal Surg 2024; 37(01): 018-021
DOI: 10.1055/s-0043-1762559
Review Article

Management of Dysplasia in Inflammatory Bowel Disease

Merrill Rubens
1   Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri
,
Radhika Smith
2   Section of Colon and Rectal Surgery, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri
› Author Affiliations Funding This publication was supported by the Washington University School of Medicine Surgical Oncology Basic Science and Translational Research Training Program grant T32 CA009621, from the National Cancer Institute (NCI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Abstract

Given the chronic nature of mucosal inflammation present in patients with inflammatory bowel disease (IBD), there is a high risk of dysplastic lesions progressing to cancer, in addition to a high risk of synchronous and/or metachronous cancers developing in those diagnosed with dysplasia. Due to this, consensus guidelines recommend regular surveillance. When visible dysplasia is encountered, options include endoscopic or surgical resection depending on characteristics of the lesion. Advancements in endoscopic tools increasingly allow for endoscopic removal when appropriate. Invisible dysplasia discovered on random biopsy should prompt referral to physicians who specialize in IBD. While surgical resection with proctocolectomy significantly decreases the risk of colorectal cancer, the risk must be balanced against the morbidity of surgery and quality-of-life concerns. Management of dysplasia in IBD patients requires complex decision-making that requires balance of patient values and goals of care with cancer-related risk factors.

Keywords

inflammatory bowel disease - dysplasia - Crohn's disease - ulcerative colitis - colorectal cancer


Publication History

Article published online:
09 April 2023

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