Role of Endoscopic Management in Ulcerative Colitis Patients with Dysplasia

Ulcerative colitis patients are at increased risk of developing colorectal cancer (CRC), and prevention strategies have been focused on secondary prevention via surveillance colonoscopies and surgical removal of the colorectum. In the past, any finding of neoplasia was an indication to recommend proctocolectomy, but advances in optical technology (including dye spray chromoendoscopy and narrow band imaging) and improved understanding of the heterogeneity of neoplastic lesion outcomes (e.g. polypoid vs. flat) have enabled a more nuanced approach to this challenge, including ongoing surveillance in patients who have had dysplastic lesions completely removed, and segmental colectomy in patients who are in remission and in whom preservation of the rectum is a reasonable option. This chapter reviews the evidence for a modified approach to dysplasia and updates the reader about newer approaches to this challenging problem.