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IBD: Management of Dysplasia in Patients with Ulcerative Colitis

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Difficult Decisions in Colorectal Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

The risk of colorectal cancer (CRC) in the ulcerative colitis (UC) population is real and is the cause of death for up to 15 % of inflammatory bowel disease (IBD) patients. Controversy surrounds the use of prophylactic colectomy when dysplasia is detected. The relatively high risk of progression to CRC must be weighed against the risks associated with total proctocolectomy (TPC) ± ileal pouch anal anastomosis (IPAA), which, in contrast, are relatively low, particularly when performed in an elective setting and by an experienced surgeon. In addition to substantially reducing the CRC risk, TPC results in the elimination of future UC flares and the necessity for medical treatment whilst eliminating the need for frequent CRC surveillance. As more powerful techniques for lesion detection become widespread, the detection of dysplasia will likely increase, increasing the relevance of the question ‘What is the most appropriate management of patients with ulcerative colitis and dysplasia?’

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Author information

Authors and Affiliations

  1. Department of Surgery, Waterford University Hospital, Waterford, Ireland

    Tara M. Connelly MB, BCh, PhD

  2. Division of Colon and Rectal Surgery, Inflammatory Bowel Disease, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA

    Walter A. Koltun MD, FRCS, FASCRS

Authors
  1. Tara M. Connelly MB, BCh, PhD
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  2. Walter A. Koltun MD, FRCS, FASCRS
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Corresponding author

Correspondence to Walter A. Koltun MD, FRCS, FASCRS .

Editor information

Editors and Affiliations

  1. Medical Center, University of Chicago, Chicago, Illinois, USA

    Neil Hyman

  2. Medical Center, University of Chicago, Chicago, Illinois, USA

    Konstantin Umanskiy

Additional information

Editor’s Note

The concepts and controversies surrounding the identification and management of dysplasia in IBD are evolving rapidly. It appears that most areas of dysplasia are actually grossly visible with high definition scopes and enhancement techniques (e.g., chromoendoscopy). If lesions can be clearly defined, they can be more readily removed endoscopically and followed carefully with serial endoscopy.

The authors have outlined an aggressive approach, especially to the management of low grade dysplasia; many IBD specialists may espouse a more nuanced view with careful endoscopic surveillance offered as an alternative for many of these patients.

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Connelly, T.M., Koltun, W.A. (2017). IBD: Management of Dysplasia in Patients with Ulcerative Colitis. In: Hyman, N., Umanskiy, K. (eds) Difficult Decisions in Colorectal Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-40223-9_10

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  • DOI: https://doi.org/10.1007/978-3-319-40223-9_10

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-40223-9

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