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UC Dysplasia Endoscopic Management — RACP Adult Medicine MCQ

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HardGastroenterologyUC Dysplasia Endoscopic ManagementRACP Adult Medicine

A patient with longstanding ulcerative colitis has a well-demarcated visible low-grade dysplastic lesion that is completely resected by an expert during high-definition chromoendoscopy. Mapping biopsies show no dysplasia elsewhere. What is the preferred management?

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Correct answer: B — Continue colon-preserving management with expert early repeat surveillance after complete resection

The best answer is “Continue colon-preserving management with expert early repeat surveillance after complete resection”. A clearly visible lesion that is completely endoscopically resected, with no synchronous dysplasia, can be managed with close expert surveillance rather than automatic colectomy. The surrounding colitis still confers field risk, so average-risk intervals and stool testing are inadequate. Surgery is discussed for unresectable, multifocal, invisible or recurrent dysplasia and according to patient preference.

Reference: Gastroenterological Society of Australia: Clinical practice resources for inflammatory bowel disease: https://gesa.org.au/Web/Resources/Clinical_Practice_Resources.aspx