J Dig Cancer Res.  2021 Dec;9(2):50-56. 10.52927/jdcr.2021.9.2.50.

Recent Advance in the Management of Dysplasia in the Ulcerative Colitis

Affiliations
  • 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

In patients having long-standing ulcerative colitis (UC), the risk of colorectal cancer (CRC) increased compared with general population. Dysplasia is a precancerous lesion of colitic patients, and traditionally total proctocolectomy was considered as a standard therapy to prevent colorectal cancer in UC patients. However, even with ileal pouch-anal anastomosis (IPAA), patients who underwent total proctocolectomy may experience early and late postoperative complications, such as ileus, bleeding, pouchitis, and so on. In addition, the bowel movement after proctocolectomy with IPAA reaches a median of seven times per day, and a considerable proportion of patients require daytime and nighttime pads. Change in the strategy for managing dysplasia started from two early studies, which suggested polypectomy for polypoid dysplasia to prevent CRC in colitic patients. After that, many studies supported that polypectomy should be the first option for the management of polypoid dysplasia. Moreover, recent studies suggested the feasibility of endoscopic submucosal dissection as a therapeutic option for nonpolypoid dysplasia, although long term, large studies should be followed.

Keyword

Ulcerative colitis; Colorectal cancer; Dysplasia; Polypectomy; Proctocolectomy
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