A 46-year-old woman with a long-standing history of ulcerative colitis undergoes surveillance colonoscopy. She is managed with oral mesalamine. During the procedure, she is noted to have mild pan colitis. One flat 10-mm polyp is seen. Biopsies of this lesion and surrounding tissue demonstrate dysplasia.
Which of the following would you recommend? Why?
A. Change her medication to an immunomodulator and repeat colonoscopy in 1 year
B. Repeat colonoscopy and perform chromoendoscopy
C. Refer for a colectomy
D. Screen her for primary sclerosing cholangitis
Answer: C. Refer for a colectomy
In patients with IBD, the risk of developing colon cancer is increased. This patient has a DALM (dysplasia associated lesion or mass), which carries a high risk of progressing to colon cancer. These lesions may be flat or polypoid, resembling an adenoma. The introduction of chromoendoscopy has improved the ability to detect dysplastic lesions. However, when lesions of this type are encountered in ulcerative colitis, the risk of malignancy is high and therefore a colectomy is recommended.