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Old 04-26-2012
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GIT Ulcerative Colitis with Low-grade dysplasia

A 40-year-old woman has an 18-year history of ulcerative colitis that is limited to the left side and has responded well to mesalamine and occasional corticosteroid enemas. Recent surveillance colonoscopy with biopsies showed low-grade dysplasia.

Which of the following is the most appropriate next step in managing this patient?
A Administer a low-dose corticosteroid
B Administer sulindac
C Refer for colectomy
D Repeat colonoscopy in 1 to 2 years
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Old 04-26-2012
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C. Refer for Colectomy (but not sure though)
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C Refer for colectomy since she has an 18-year history of ulcerative colitis and now showed low-grade dysplasia.
That was the whole point for doing surveillance.
Initially I thought D Repeat colonoscopy in 1 to 2 years was the right answer but missed the duration of her disease. Colectomy is indicated for patients who has the disease for > than 10 years and shows dysplasia on biopsy.

Last edited by Novobiocin; 04-26-2012 at 01:56 PM.
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Quote:
Originally Posted by usmlestep View Post
C. Refer for Colectomy (but not sure though)
There is so much controversy regarding the management of this.

Quote:
Most centers recommend proctocolectomy for confirmed low-grade dysplasia, high-grade dysplasia, or
dysplasia-associated lesion/mass complicating preexistent ulcerative colitis. While this recommendation
for low-grade dysplasia might be justified when neoplasia is discovered in flat mucosa biopsied during an initial
colonoscopy, the literature does not necessarily support
the same approach if low-grade dysplasia develops in an
individual monitored by an appropriately conducted surveillance program. In this latter instance, the risk of concomitant colorectal cancer appears to be no greater than
that seen with a person whose surveillance biopsy results
were indefinite for dysplasia. Accordingly, there may be
a role for observation in selected individuals with otherwise minimal risk factors and a history of compliant
follow-up. Emerging molecular data may help us to acquire future tools that can reliably identify persons with
ulcerative colitis who are at significant risk for imminent
neoplasia.

http://www.laboratoriosilesia.com/up.../GA0307288.pdf

http://onlinelibrary.wiley.com/doi/1...7000-00009/pdf

http://www.ncbi.nlm.nih.gov/pubmed/14598247

http://www.ig-ibd.com/wp-content/upl...o/caso4/10.pdf

http://gut.bmj.com/content/51/suppl_5/v10.full
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Correct Answer = C

This patient requires referral for a prophylactic colectomy. The finding of low-grade dysplasia on surveillance colonoscopy is associated with concurrent adenocarcinoma or progression to high-grade dysplasia and cancer in up to 24% of patients with chronic ulcerative colitis. Current guidelines recommend colectomy for patients with chronic ulcerative colitis and dysplasia of any grade. Neither increased colonoscopic surveillance nor more aggressive medical therapy (such as administration of sulindac or a low-dose corticosteroid) has been found to reduce the risk of cancer in these patients. Repeating the colonoscopy in 1 to 2 years places this patient at increased risk for the development of colon cancer.

Key Point
Patients with chronic ulcerative colitis and dysplasia of any grade detected on surveillance colonoscopy should be referred for colectomy.
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C Refer for colectomy
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Old 04-26-2012
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Please pm me the source of the question.
Thanks.
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Gastroenterology-, Internal-Medicine-, Step-2-Questions

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