Management of Abnormal Findings

A finding of histologic lesions "indefinite for dysplasia", confirmed by 2 expert pathologists, warrants strict surveillance with repeat endoscopy within 3 months [33]. A finding of high-grade dysplasia indicates total colectomy because of the high risk of synchronous or metachronous CRC [34, 35]. Management of low-grade dysplasia is uncertain because it can progress to high-grade dysplasia or cancer in approximately 35-50% of patients within 5 years. Hence, 20% of patients with low-grade dysplasia have a CRC diagnosed at prophylactic total colectomy. Therefore, different therapeutic options should be considered. Prophylactic colectomy should be recommended if the number of specimens is poor or in multifocal dysplastic areas. If the patient declines prophylactic colectomy, careful surveillance should be carried out by a colonoscopy with adequate biopsies every 3-6 months. Negative sequential colonoscopy should not encourage patient or physician, and surveillance must continue every 6 months [33].

In the case of polyps in UC mucosae [adenomalike mass (ALM)], polypectomy is indicated and, moreover, biopsies should be taken in the surrounding area (for separate examination). If those are negative for dysplasia, surveillance should be carried out every 6 months; however, if dysplasia is present on the mass or in the adjacent area, colectomy is indicated because of the high risk of synchronous CRC [11,19, 36-38]. If the polyp is on either macroscopi-cally or microscopically healing areas, follow-up is similar to those of sporadic adenoma.

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