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Volume 7, Issue 6 (Suppl)
J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X
Page 18
Notes:
December 07-08, 2017 Madrid, Spain
&
13
th
International Conference on Clinical Gastroenterology & Hepatology
2
nd
International Conference on Digestive Diseases
CO-ORGANIZED EVENT
Dysplasia in inflammatory bowel disease in 2017
D
espite increased general awareness, colorectal cancer (CRC) remains the second leading cause of cancer-related death in
Canadian men and with a third of CRC patients dying from this disease. These are grim statistics given that this cancer
is a well-studied malignancy with defined risk factors, a slow progression, and pre neoplastic lesions that can be detected and
treated by colonoscopy. In this context, it is well-recognized that patients with long-standing inflammatory bowel disease (IBD)
colitis have a 2.4-fold higher risk of developing colorectal cancer (CRC) than the general population. Surveillance colonoscopy
is recommended to detect dysplasia, the precursor of CRC, in order to potentially prevent or cure CRC. Colonoscopy is
the gold standard examination to screen for colorectal neoplasms in patients without IBD in whom it has relied on careful
examination of the mucosa for ‘polyps’ “
visible dysplasia
” to interrupt the ‘adenoma-carcinoma’ sequence. In contrast, routine
colonoscopy for surveillance of dysplasia in IBD has relied on extensive random biopsies to identify “
invisible dysplasia
” to
interrupt the “inflammation-dysplasia-carcinoma sequence”. Traditionally, dysplasia is classified microscopically as low-grade
(LGD), high-grade (HGD), or indefinite dysplasia (IND). HGD is associated with a high risk of synchronous or metachronous
CRC and is therefore generally considered an unambiguous indication for colectomy in a setting of IBD where the process is
felt to be multifocal. Decision-making in case of flat LGD and IND, however, is not straightforward. Progression rates of flat
LGD to HGD or CRC vary greatly in previous reports, ranging from no progression to 5-year progression rates of more than
50%. Additionally, dysplasia in the indefinite and low-grade categories in particular is associated with a poor inter observer
agreement. The termDALM ‘dysplasia associate lesion/mass’ can be very confusing as it is not specific. A DALM can be a polyp,
non-polypoid lesion or mass. Recently, the Scenic International Consensus [SCENIC] has developed two recommendations
on a) how should dysplasia be described macroscopically; and b) how should the statement be implemented into practice.
A subgroup of SCENIC panelists have developed a new set of terms to describe the macroscopic appearance of dysplasia
using descriptive terms with a recommendation to abandon the term ‘DALM”. In this presentation, the new recommended
classification for dysplasia in IBD will be shared that will result in the paradigm clinical shift from random biopsy techniques to
targeted high definition chromoendoscopic biopsy techniques for the identification of “
visible and
invisible dysplasia
” in IBD.
Biography
Rani Kanthan is a Consultant Anatomical Pathologist in the Dept. of Pathology and Laboratory Medicine at the University of Saskatchewan with a focused interest in Sur-
gical Oncology including breast and gastrointestinal tract. She has published 120 peer reviewed manuscripts that are indexed in PubMed/Google scholar and serves as
an Editorial Board Member in various journals. She is an active medical educator and continues to participate and present at various national and international meetings
with more than 125 conference abstract presentations to her credit.
rani.kanthan@saskatoonhealthregion.caRani Kanthan
University of Saskatchewan, Canada
Rani Kanthan, J Gastrointest Dig Syst 2017, 7:6(Suppl)
DOI: 10.4172/2161-069X-C1-057