HGD in Crohn's colitis: colectomy or endoscopic resection

What is known

• IBD patients with HGD, multifocal LGD, or a non-adenoma dysplasia-associated lesion should undergo total proctocolectomy; segmental resection has a limited role given secondary-malignancy risk. ¹
• In Crohn's colectomy for dysplasia, preoperative HGD predicted final HGD/cancer in 73%; 44% of TPC/STC specimens had multifocal dysplasia and 40% of cancers had remote dysplasia. ²
• For colonic Crohn's with multifocal or high-grade dysplasia, total colectomy with IRA or proctocolectomy is recommended because of field effect and synchronous-lesion risk. ³
• Endoscopic (EMR/ESD) removal is described for well-defined, small, liftable, unifocal LGD, not HGD. ⁴

What is unknown / caveats

• Dysplasia data in Crohn's are sparse and largely extrapolated from ulcerative colitis
• Choice between total colectomy with IRA vs proctocolectomy depends on degree of rectal inflammation
• The retrieved evidence describes endoscopic resection only for small unifocal LGD, not for HGD, so no direct EMR-vs-colectomy comparison for HGD exists.

References

1. Ansell J, Grass F, Merchea A. Surgical Management of Dysplasia and Cancer in Inflammatory Bowel Disease. Surg Clin North Am. 2019;99(6):1111-1121. PMID: 31676051.

2. Kiran RP, Nisar PJ, Goldblum JR, Fazio VW, Remzi FH, Shen B, Lavery IC. Dysplasia associated with Crohn's colitis: segmental colectomy or more extended resection?. Ann Surg. 2012;256(2):221-6. PMID: 22791098.

3. Macleod A, Kavalukas SL, Scheurlen KM, Galandiuk S. State-of-the-art surgery for Crohn's disease: Part II-colonic Crohn's disease and associated neoplasms. Langenbecks Arch Surg. 2022;407(7):2595-2605. PMID: 35729401.

4. Khan F, Shen B. Inflammation and Neoplasia of the Pouch in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2019;21(4):10. PMID: 30815755.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.