SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2023 | VOLUME 21 | ISSUE 1 | 8 Table 2: Therapeutic management of dysplasia Endoscopic features Therapeutic management Follow up Polypoid lesion OR Non-polypoid lesion ≤ 2cm without stigmata of invasive cancer or fibrosis and distictive border Endiscopic en-bloc resection (EMR,ESD, Hybrid ESD). Undertaken by expert endoscopist. Close surveillance with DCE or VCE plus targeted biopsies. HGD: 3 months for the first year annually. Non-polypoid LGD: 6months for the first year then annually. Polypoid <1cm or pedunculated LGD: 12 months. Non-polypoid larger lesion > 2cm without stigmata of invasive cancer or fibrosis and distinctive border Endoscopic en-bloc resection (ESD) by expert endoscopist. Surgery as an alternative to endoscopic resection. Intense surveillance with DCE or VCE plus targeted and random biopsies. Every 3-6 months for the first year and then annually. Unresectable large lesion (indistinctive borders ), invasive cancer Surgery. Invisible dysplasia on random biopsies Confirmation by second pathologist. Repeat surveillance colonoscopy with DCE plus random and targeted biopsies by an expert endoscopist. Unmask visible dysplasia as above. Persistent unifocal invisible LGD: consider intensive DCE surveillance follow up. Persistent unifocal invisible HGD: consider colectomy. Indefinite dysplasia Conifrmation by second pathologist. Optimise therapy and control inflammation. Repeat surveillance colonoscopy with DCE or VCE plus random targeted biopsies in quiescent disease. Annual surveillance colonoscopy. Multifocal dysplasia LGD or HGD Surgery. In selected cases of colonic lesions with discrete borders, en-bloc endoscopic resection can be considered following MDT. Surgery. If endoscopic resection is undertaken, surveillance should be performed every 3 months for the first year then annually. Sporadic adenoma in IBD Endoscopic en-bloc resection. Surveillance colonoscopy as per post- polypectomy guidelines. *EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; DCE, dye-based chromoendoscopy; VCE, virtual electronic chromoendoscopy (VCE); PSC, HGD, high grade dysplasia; LGD, low grade dysplasia; MDT, multidisciplinary team. Adapted from Gordon, H., et al 19