Colonoscopic polypectomy in chronic colitis: Conservative management afterendoscopic resection of dysplastic polyps

Background & Aims: Adenomatous polyps are by definition dysplastic and path ologically indistinguishable from the dysplasia-associated lesion or mass ( DALM) described in 1981. Yet, adenomatous polyps in noncolitic colons are u sually removed definitively endoscopically, whereas DALMs are regarded as h arbingers of colon cancer, mandating colectomy, Methods: Since 1988, all of our patients with chronic ulcerative or Crohn's colitis and dysplastic pol yps and no coexistent dysplasia in flat mucosa underwent colonoscopic polyp ectomy, Biopsy specimens were obtained also adjacent to polypectomy sites, from strictures, and throughout the colon at 10-cm intervals, Follow-up col onoscopies and biopsies were performed within 6 months after polypectomy an d yearly thereafter. Results: Colonoscopy in 48 patients with chronic colit is (mean duration, 25.4 years) resected 70 polyps (60 in colitic and 10 in noncolitic mucosa), Polyps were detected on screening colonoscopies (29%) a nd on surveillance (71%), Pathology was tubular adenoma in all polyps from noncolitic mucosa and low-grade dysplasia (57), high-grade dysplasia (2), o r carcinoma (1) in polyps from colitic mucosa, Subsequent colonoscopies (me an follow-up, 4.1 years) revealed additional polyps in 48% but no carcinoma s, Surgical resection (6 patients) for recurrent polyps confirmed colonosco pic findings. No dysplasia or cancers in flat mucosa were found at surgery or on follow-up colonoscopies, Conclusions: In patients with chronic coliti s who have no dysplasia in flat mucosa, colonoscopic resection of dysplasti c polyps can be performed effectively,just as in noncolitic colons.