The present status and problems with diagnosis and management of dysplasia/colitic cancer in ulcerative colitis

Patients with long-standing UC (ulcerative colitis) have an increased risk of colorectal cancer. Colonoscopic surveillance for UC patients is generally accepted to reduce mortality due to colitic cancer. However, the diagnosis and management of dysplasia remain controversial. The literature about the present status of and problems with diagnosis and management of dysplasia/colitic cancer was reviewed. The problems that arise are: (1) the surveillance program is different in each guideline; (2) the biopsy number that the guidelines propose for surveillance is too large to observe, and there is no adequate evidence of benefit from this number; (3) direct evidence to prove the efficacy of the present surveillance methods is not shown; (4) significant variability is thought to exist between diagnosticians in the diagnosis of low-grade dysplasia (LGD) and indefinite dysplasia (IND); (5) a consensus has not been reached about the management of flat LGD; (6) there is disagreement about the definition of dysplasia-associated lesions (DALM), and there are cases where the differentiation of DALM, adenoma-like mass (ALM)/adenoma-like dysplasia (ALD), sporadic adenoma and even inflammatory polyps is difficult.