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Dysplasia in Ulcerative Colitis

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Due to the increased risk of dysplasia and malignancy, patients with ulcerative colitis are put under surveillance protocols for early detection. Surveillance colonoscopies are begun 8 years after the initial diagnosis or at the time of diagnosis if they also have coexistent primary sclerosing cholangitis. Colonoscopies are performed every 1-2 years, preferably during inactive phase of the disease.

Four-quadrant biopsies are performed every 10 cm throughout the colon. In addition, targeted biopsies from any raised or suspicious areas are taken. The image shows a tubular adenoma-like focus in a patient with ulcerative colitis. A large crypt abscess is present near the right edge of the image. See next slide for terminology used in describing dysplasia in the setting of inflammatory bowel disease.

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