Polypoid lesions in inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) may develop a variety of neoplastic and nonneoplastic polyps. This review covers the pathology, pathogenesis, natural history, and treatment of polyps in IBD with special emphasis on dysplastic lesions. Elevated or polypoid dysplastic lesions in IBD patients are referred to by the acronym DALM (dyspasia-associated lesion or mass). DALMs are further categorized as adenoma-like (endoscopically resectable polypoid dysplasia) or non–adenoma-like (non–endoscopically resectable polypoid dysplasia) based on their endoscopic appearance. Colectomy is recommended for patients with a non–adenoma-like DALM because of the high risk of synchronous or metachronous adenocarcinoma. In contrast, adenoma-like DALMs can be safely treated by polypectomy and continued surveillance provided that the lesion is removed in total, with negative margins, and no flat dysplasia is identified in the colon adjacent to and distant from the polyp.