What should be the protocol to manage high grade dysplasia in IBD?

From Cancer Guidelines Wiki

If high grade dysplasia (HGD) is diagnosed in flat mucosa and confirmed by a separate pathologist, surgery is usually required. According to a review of 10 dysplasia studies, a finding of high grade dysplasia was accompanied by actual cancer in 42%, and in the rest who underwent surgery, definite dysplasia was usually detected in colectomy specimens.[1] Experience from the 30 year St Mark’s Hospital surveillance programme found that 19/600 (3.2%) developed HGD. Of these, 11 underwent immediate colectomy and five (45%) had cancer in the operative specimen. Eight patients refused immediate surgery, of whom two subsequently developed CRC. In total, 37% of all patients with HGD eventually developed CRC.[2]

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Evidence summary and recommendations

Evidence summary Level References
The predictive value of HGD for imminent or established cancer is high. II [2], [1]
Recommendation Grade
High grade dysplasia in flat mucosa is a strong risk factor for established or imminent carcinoma, and colectomy is usually recommended.

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  1. 1.0 1.1 Bernstein CN, Shanahan F, Weinstein WM. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis? Lancet 1994 Jan 8;343(8889):71-4 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7903776].
  2. 2.0 2.1 Rutter MD, Saunders BP, Wilkinson KH, Rumbles S, Schofield G, Kamm MA, et al. Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology 2006 Apr;130(4):1030-8 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16618396].

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