Surveillance Colonoscopy in Ulcerative Colitis: A Surgical Perspective

The “surgical” perspective of surveillance in ulcerative colitis can vary depending on whether the surgeon is the primary individual responsible for performing surveillance colonoscopy, or only consulted when dysplasia is identified, or consulted when there is uncertainty regarding the most appropriate clinical care for a given patient. In the former case, issues such as chemoprophylactic medication, timing and frequency of surveillance, choosing the type of colonoscopic imaging, and choosing the pathologist and number of biopsies are important. In the latter situation, it is important to determine the expertise of the referring endoscopist and reviewing pathologist before proceeding. Never decide on surgery without a rereview of the pathology by a specialist gastrointestinal pathologist with experience in inflammatory bowel disease. Also, in choosing the best operation, ensure the adequate biopsies have been performed. For example, before deciding to perform a stapled ileal pouch-anal anastomosis, ensure the rectum has been adequately sampled to exclude the presence of dysplasia before proceeding. Decisions regarding management and surveillance of dysplasia should be weighed with patient age and other risk factors.