Endoscopic approach to resection of polypoid and non-polypoid dysplasia in IBD

Abstract

The endoscopic management of dysplasia in inflammatory bowel disease (IBD) patients has many similarities with the management of complex colorectal neoplasia in non-IBD patients. There is a need for a skilled operator, experienced nursing team, and surgical backup; however, the context of IBD leads to additional challenges for the endoscopist where the patient must be considered as a whole and over the lifetime of their disease. Major considerations include: proof of a curative resection, multifocal or non-circumscribed dysplasia, and consequences of surgery including stoma. A multi-disciplinary working group is critical. The endoscopic resection technique should be chosen after careful considerations of its risks and benefits. Endoscopic dysplasia resection in IBD represents one of the greatest challenges to the therapeutic endoscopist both in terms of skill and judgement. This chapter highlights some of the pitfalls and offers potential solutions.