What should be the protocol to manage indefinite dysplasia in IBD?

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If Indefinite dysplasia (ID) is diagnosed, the rate of progression to a higher grade of dysplasia or carcinoma is unusual. At St Mark’s Hospital, 1/23 patients with ID (4%) eventually developed carcinoma and five (22%) developed LGD after nine years follow-up.[1] In contrast, data from New York showed that the five year rate of progression from indefinite dysplasia to HGD or cancer was 9%.[2] If a biopsy is diagnosed as indefinite for dysplasia by two gastrointestinal pathologists, follow-up surveillance colonoscopy, preferably with chromoendoscopy, at six months is reasonable, and thereafter at annual intervals.

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Evidence summary and recommendations

Evidence summary Level References
The predictive value of indefinite dysplasia in flat mucosa for imminent cancer is low. II [1], [2]
Recommendation Grade
Indefinite dysplasia in flat mucosa does not require surgery, but follow-up colonoscopic surveillance is justified, preferably with chromoendoscopy, at more frequent intervals.
B

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References

  1. 1.0 1.1 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].
  2. 2.0 2.1 Ullman T, Croog V, Harpaz N, Hossain S, Kornbluth A, Bodian C, et al. Progression to colorectal neoplasia in ulcerative colitis: effect of mesalamine Clin Gastroenterol Hepatol 2008 Nov;6(11):1225-30; quiz 1177 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18848502].

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Appendices

View body of evidence View body of evidence View initial literature search View literature search documentation