Dysplasia in Inflammatory Bowel Disease: Historical Review, Critical Histopathological Analysis, and Clinical Implications

Colorectal cancer is the most serious complication of chronic inflammatory bowel disease. It is generally accepted that dysplasia in most cases precedes the development of colorectal cancer. Thus, detection of dysplasia through surveillance may allow therapeutic interventions to lower the risk of cancer. Our understanding of dysplasia has evolved over the past decades and guided rational decision-making, but many questions remain unanswered. We are currently at the brink of a new era, where new avenues in the endoscopic detection and management of dysplasia are pursued, and the paradigm of a colectomy being the preferred treatment for advanced neoplasia is changing. This review provides a histopathological characterization of dysplasia and aims at summarizing our current understanding of the disease from a clinical point of view. Management algorithms presented seek to aid clinicians and patients in dealing with dysplasia, and future perspectives are discussed.