Strategies for the Treatment of Dysplasia at an Institution in Japan

Background:
The treatment policy for colorectal cancer in ulcerative colitis is total colectomy. This is indicated in the guidelines of each country, and a consensus has been reached. However, there is no consensus on dysplasia treatment policy and the optimal surveillance interval. Recently, endoscopic resection should be considered for lesions with clear margins where background mucosal healing has been achieved. However, in actual clinical practice, we often encounter lesions where background mucosal healing has not been achieved, margins are unclear, and lesions are invisible on random biopsy. Therefore, we aimed to clarify the current status of treatment for dysplasia at our institution in Japan and to determine the optimal surveillance interval after dysplasia detection.
Methods:
The study retrospectively evaluated the treatment strategy and endoscopic surveillance interval for dysplasia in patients with ulcerative colitis and dysplasia who had visited our institution between April 2011 and March 2023.
Results:
Twenty-seven patients were included in the study. The median patient age at the time of ulcerative colitis onset and dysplasia detection was 35 (range: 9-79) and 50 (range: 18-85) years, respectively, and the median time to dysplasia detection was 8.7 (range: 0-38) years. After dysplasia detection, only 1 patient underwent endoscopic resection. All other patients were followed up with endoscopy and biopsy. Five patients (18.5%) had cancer and 4 underwent total colectomy. The final diagnosis after treatment was stage 0-I, and all the patients have survived to date. For the 4 patients who underwent total colectomy, the endoscopic surveillance interval between dysplasia detection and cancer diagnosis was 3.8 (range: 0.9-5.9) months.
Conclusions:
After the detection of dysplasia that is not amenable to endoscopic resection, close endoscopic surveillance for less than 1 year improves patient survival.