A 34-year-old man has had pancolonic ulcerative colitis for nine years and is currently in clinical remission on mesalazine. According to standard surveillance recommendations, what should be done?

• A No surveillance needed until symptoms recur
• B Prophylactic proctocolectomy once disease duration exceeds eight years
• C Surveillance colonoscopy with multiple biopsies for dysplasia every 1 to 2 years ✓
• D Annual fecal occult blood testing as the sole surveillance tool

Explanation

Colorectal cancer risk in ulcerative colitis rises significantly after eight to ten years of extensive colitis, so surveillance colonoscopy with systematic biopsies for dysplasia is recommended every one to two years thereafter. Fecal occult blood is insensitive for dysplasia, and prophylactic colectomy is reserved for confirmed high-grade dysplasia or multifocal low-grade dysplasia, not duration alone. Surveillance continues regardless of symptom status because dysplasia is silent.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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