Dysplasia in ulcerative colitis: still a challenge

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Mauro Frego, Marco Scarpa, Alessio Bridda, Norberto Lorenzo, Maurizio Iacobone, Giorgio Bianchera

Ann. Ital. Chir., 2010 81: 5-10

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As duration of inflammatory bowel disease (IBD), in particular ulcerative colitis (UC), is a major risk factor for the
development of colorectal cancer (CRC), it is rational to propose a screening colonoscopy when the risk starts to
increase, i.e. after 8-10 years from the onset of disease. If low-grade dysplasia is detected, the 9-fold increased risk
of developing CRC reported in the most recent meta-analysis could reasonably be viewed as justification for colectomy
even if some follow-up studies have shown a lower rate of CRC. A reasonable compromise could be to continue
surveillance with extensive biopsy sampling at shorter (perhaps 3-6 month) intervals. If high grade dysplasia
is present, the decision is easier, because the risk of concomitant CRC may be as high as one third, assuming that
the biopsies were indeed obtained from flat mucosa and not from an adenoma. Total proctocolectomy with ileal
pouch anal anastomosis (IPAA) has become the most commonly performed procedure for patients with ulcerative colitis
requiring elective surgery for dysplasia. Nevertheless, a recent systematic review alerted that the risk of dysplasia
in anal transition zone and rectal cuff in patients undergone to restorative proctocolectomy was remarkable, mainly
in patients operated on for dysplasia or colorectal cancer.

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