Management of Dysplasia in IBD

Patients with long-standing inflammatory bowel disease (IBD) of the colon are at increased risk of developing colorectal neoplasia (CRN), which is thought to develop along the inflammation-dysplasia-neoplasia sequence. Whereas in the past, a finding of any degree of dysplasia in the setting of IBD colitis was managed with surgery, our ability to manage dysplasia endoscopically with enrollment in an endoscopic surveillance program and/or endoscopic resection has been a major paradigm shift. Successful dysplasia surveillance programs are multidisciplinary and require not only close communication between the gastroenterologist, pathologist, and colorectal surgeon with experience in IBD, but more importantly with the patient to ensure close adherence to follow-up and therapy. Whether our enhanced endoscopic technologies and techniques, as well as improved medical therapies to control inflammation have altered the natural course of CRN in IBD remains to be determined. This chapter focuses on the multimodal management of dysplasia in IBD colitis.