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UC Dysplasia Management — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyUC Dysplasia ManagementRACP Adult Medicine

A 55-year-old man with longstanding ulcerative colitis (20 years) undergoes surveillance colonoscopy. Random biopsies from the flat mucosa reveal multifocal low-grade dysplasia (confirmed by two pathologists). What is the recommended management?

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Correct answer: E — Proctocolectomy

Confirmed multifocal low-grade dysplasia in longstanding UC carries a high risk of synchronous or metachronous colorectal cancer (~30–50% when multifocal). Proctocolectomy is recommended. If the dysplasia is unifocal and amenable to endoscopic resection (e.g., a dysplasia-associated lesion or mass – DALM), endoscopic resection plus intensive surveillance is an alternative. However, flat multifocal dysplasia is NOT amenable to endoscopic resection. The duration of UC (>8–10 years) is the primary risk factor for dysplasia development.

Reference: eTG – 2025 – Gastrointestinal; ECCO – 2022 – UC Surveillance Guidelines