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Hépato-Gastro & Oncologie Digestive

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Colonic dysplasia in IBD : management in 2010 Volume 17, special issue 4, Volume 17, numéro spécial 4

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Authors
Services d'hépato-gastroentérologie, de chirurgie et d'anatomie pathologique, Centre hospitalier Lyon Sud, 69495 Pierre-Benite

Given the difficulty and consequences of a diagnosis of dysplasia, any dysplasia, whether low-grade dysplasia, high-grade dysplasia or indefinite for dysplasia, should be confirmed by a second pathologist. A diagnosis of high-grade dysplasia on plane, or apparently plane, colic mucosa should lead to proctocolectomy. The management of a low-grade dysplasia on plane, or apparently plane, colic mucosa is still debated, some experts advise proctocolectomy, whereas others recommend a strict endoscopic surveillance program. After polypectomy or biopsies, if a dysplasia is found on a polypoid lesion, located in a segment macroscopically and histologically spared by the colitis, the lesion must be considered as sporadic adenoma and requires only the usual follow-up screening for this type of lesion. If the polypoid lesion is located within a segment that is or has previously been affected by the colitis, polypectomy is a sufficient treatment provided that the lesion is a simple adenoma, has been or could later be completely removed, that there is no dysplasia at the polyp base, no other dysplastic lesion elsewhere in the colon and that the colon can easily be screened and some would add that the patient is older than 40. Finally, if the dysplastic lesion does not look like a conventional adenomatous polyp, if its endoscopic resection appears difficult and dysplasia is also found around the lesion or at a distance elsewhere in the colon, the lesion should be considered as a DALM and requires a proctocolectomy.