Elevating the Technique: Resecting Complex Dysplastic Lesions of the Colon in Patients with Inflammatory Bowel Disease

  • Eshandeep S. Boparai
  • Fernando S. VelayosEmail author
  • Abhik Roy
  • Carolyn Li
  • Ahmed S. Alkoraishi
  • Craig A. Munroe
Multicenter Seminars: IBD (MUSE: IBD)

Case Presentation


A 50-year-old woman with no significant past medical history was referred for upper endoscopy and colonoscopy in order to investigate iron deficiency anemia. Laboratory values include a hemoglobin of 10.7 g/dL, mean corpuscular volume of 74 fL, iron level of 45 ug/dL, and ferritin < 5 ng/mL. She denied menorrhagia, diarrhea, melena, or overt rectal bleeding.

Upper endoscopy was normal. Unexpectedly, colonoscopy revealed erythema, mild friability, and small erosions from the anal verge to the cecum (Mayo endoscopic subscore 1–2). Findings were consistent with mild–moderate ulcerative colitis. Also noted was an unexpected 60-mm polypoid rectal lesion, 5 cm from the anal verge, characterized by granular morphology and indistinct margins (Paris classification IIa + Isp) (Fig.  1). Biopsies of the colon revealed chronic active colitis; biopsies of the lesion revealed high-grade dysplasia (HGD). Stool studies were negative. The histologic findings and...


Advanced endoscopy Endoscopic submucosal dissection Inflammatory bowel disease Colorectal dysplasia 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Eshandeep S. Boparai
    • 1
  • Fernando S. Velayos
    • 2
    Email author
  • Abhik Roy
    • 3
  • Carolyn Li
    • 4
  • Ahmed S. Alkoraishi
    • 5
  • Craig A. Munroe
    • 2
  1. 1.Department of Internal MedicineKaiser Permanente San FranciscoSan FranciscoUSA
  2. 2.Department of Gastroenterology and HepatologyKaiser Permanente San FranciscoSan FranciscoUSA
  3. 3.Department of Gastroenterology and HepatologyKaiser Permanente San LeandroSan LeandroUSA
  4. 4.Department of PathologyKaiser Permanente San FranciscoSan FranciscoUSA
  5. 5.Department of Colorectal SurgeryKaiser Permanente San FranciscoSan FranciscoUSA

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