Colonoscopic Surveillance in Inflammatory Bowel Disease

Thomas A Ullman

Disclosures

Curr Opin Gastroenterol. 2005;21(5):585-588. 

In This Article

Management of Small Polypoid Lesions

As opposed to the continued controversy over flat LGD, the management of raised LGD appears to be moving toward consensus. Blackstone et al.[16] demonstrated the horrid prognosis for raised lesions in their seminal publication on dysplasia-associated lesion or mass (DALMs) over 2 decades ago. Many have wondered whether all raised lesions carried the same 58% rate of cancer. Because small polyps in colitis-free patients can be managed conservatively with simple polypectomy, it stood to reason that such an approach could be entertained in ulcerative colitis despite the findings of Blackstone et al..[16]

In 1999, Rubin et al.[17] from New York and Englesgjerd et al.[18] from Boston convincingly demonstrated that simple polypectomy is a safe strategy in the management of small sessile lesions in patients with ulcerative colitis enrolled in a surveillance program. In both groups, no patients progressed to CRC. In recent months, the Boston group has published additional data in which the safety of this strategy was underscored by longer follow-up.[19]

Although endoscopists should take heart in the safety of this strategy, how to individualize patients with ulcerative colitis with this approach remains uncertain. Should we treat a 28-year-old with longstanding ulcerative colitis and primary sclerosing cholangitis (PSC) with a polypectomy as we would a 75-year-old with a similar history? To date, this question remains unanswered, although the Boston and New York data should give us all comfort.

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