Surveillance colonoscopy in a 48-year-old man with ulcerative colitis of 15 years duration involving the entire colon detects flat low-grade dysplasia in the sigmoid colon, confirmed by a second pathologist. There is no visible discrete lesion. What is the recommended management?
- A Proctocolectomy ✓
- B Continue routine 5-yearly surveillance
- C Repeat surveillance colonoscopy in 1 year
- D Local endoscopic mucosal resection of the area
Correct answer: A. Proctocolectomy
Explanation
Unifocal flat low-grade dysplasia confirmed by an expert gastrointestinal pathologist carries a substantial risk of synchronous or metachronous advanced neoplasia, and guidelines recommend colectomy as the preferred option in fit patients. Endoscopic resection applies only to visible, circumscribed lesions with clear margins, not flat dysplasia. Mere annual surveillance underestimates cancer risk, and extending the interval to 5 years is clearly unsafe once any grade of dysplasia is found.
Reference: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.