Time sensitive managements in hepato-gastroenterology

Table 7 Surveillance for inflammatory bowel disease -related colonic dysplasia

Visible dysplastic lesions
Lesion	Treatment	Colonoscopy surveillance intervals
Small < 2 cm + resectable + no histologic features of invasive CRC	Endoscopic resection + continuous surveillance	Every 3-6 months in HGD or incomplete resection; 12 months: More than 1 cm and LGD; 24 months if < 1 cm, pedunculated, LGD
Large ≥ 2 cm, complex lesions, incomplete resection, after several attempts, local recurrence	Refer to a highly experienced center for resection vs surgery	Every 3-6 months if resected
Non-visible dysplastic lesions (detected by non-targeted biopsy) or incompletely delineated lesions on target biopsy should be examined by SDC
Persistent HGD or multifocal invisible dysplasia	Surgery
Persistent unifocal low-grade invisible dysplasia	Intensive surveillance with SDC	Every 3-6 months in HGD or multifocal dysplasia; 6-12 months: If LGD continues, surveillance till 2 consecutive negative high-quality SDC colonoscopies
No dysplasia at index colonoscopy; timing for the next colonoscopy depends on many factors for CRC risk
1-year	2-3 years	5-year
Moderate or severe inflammation at index colonoscopy; family Hx of CRC in FDR < 50 years; PSC; dense pseudo-polyposis; history of invisible dysplasia < 5 years	Mild inflammation at index colonoscopy; strong family Hx of CRC but no FDR < 50 years; features of prior severe colitis (moderate pseudo-polyposis + extensive scarring); history of invisible dysplasia > 5 years	Continuous disease remission since the last colonoscopy with mucosal healing on the current examination, plus either: ≥ 2 consecutive exams without dysplasia; minimal historical colitis extent (ulcerative proctitis or < 1/3 in Crohn’s disease)

CRC: Colorectal cancer; HGD: High-grade dysplasia; LGD: Low-grade dysplasia; SDC: Sebaceous duct carcinoma; FDR: First-degree relative; PSC: Primary sclerosing cholangitis.