Inflammatory bowel disease-related dysplasia: evolving diagnostic and therapeutic paradigms

Patients with inflammatory bowel disease show an excess colon cancer incidence and mortality. Colonoscopy with biopsies represents the most robust strategy for decreasing the risk of malignancy. Targeted biopsies of lesions identified on a high-resolution endoscope and chromoendoscopy is now believed to be a more efficient means of detecting dysplasia, and random biopsies do not increase the yield of neoplasia. In clinical practice, the diagnosis of dysplasia is based on a constellation of changes that include cytologic, architectural and maturational abnormalities. Morphologically, most dysplasia is of the adenomatous type. The distinction of low-grade dysplasia from reactive epithelial changes remains a significant and sometime an insurmountable problem. Although p53 immunohistochemistry has been proposed as a biomarker for dysplasia, positive staining reactive conditions significantly limits its utility as a marker of dysplasia. The advent of high resolution endoscopes and chromoendoscopy allows for the visualization of the vast majority of dysplastic lesions, leaving only a minority of lesions are endoscopically invisible. Advances in screening and endoscopic resection techniques now permit conservative management of endoscopically visible dysplastic lesion, including some cases of high-grade dysplasia.