A 45-year-old man with ulcerative colitis for 20 years is found to have high-grade dysplasia in the sigmoid colon on surveillance colonoscopy. He has no symptoms. What is the MOST appropriate next step?
- A Repeat surveillance colonoscopy in 3 months
- B Endoscopic mucosal resection of the dysplastic area
- C Proctocolectomy with ileal pouch-anal anastomosis ✓
- D Intensify medical therapy and repeat biopsy in 6 months
Correct answer: C. Proctocolectomy with ileal pouch-anal anastomosis
Explanation
High-grade dysplasia found on surveillance colonoscopy in a patient with long-standing ulcerative colitis is an indication for colectomy (proctocolectomy with IPAA if feasible), as the risk of synchronous or subsequent colorectal carcinoma is very high (30-50%). Unlike sporadic polyps, dysplasia in UC is often flat and multifocal, making endoscopic resection inadequate. The restorative proctocolectomy with IPAA is the procedure of choice in suitable patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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