Benefits of laparoscopy include decreased postoperative pain and quicker

return to function; moreover, laparoscopy may allow appropriate patients earlier access to definitive medical oncology treatments. The repeated cycle of inflammation, necrosis, and ulceration, alternating http://www.selleckchem.com/products/BKM-120.html with the deposition of granulation tissue during the healing phase, results in the development of raised areas of inflamed tissue that resemble polyps, called pseudopolyps, or may result in stricture formation. Such sequelae make endoscopic surveillance of dysplasia and cancer, and its management, a challenge. Colonic strictures are more common in Crohn’s disease than in UC. Colonic strictures reportedly are found in 5% to 17% of patients with Crohn’s colitis.10 Although data are lacking, colonic strictures have been reported in approximately 5% of UC patients. Rates of stricture

occurrence seem to be improving as medical treatments allow more patients to achieve remission. Panobinostat Colonic strictures in any setting should be considered malignant until proven otherwise. Gumaste and colleagues33 evaluated the Mount Sinai Hospital (New York) population of UC patients with strictures, and found 29% to be malignant. In Crohn’s disease, despite a higher rate of stricture occurrence, the rate of malignant colorectal strictures was only 6.8%.34 There is no role for stricturoplasty in the primary management of colonic strictures in IBD. Strictures found at prior anastomotic sites in Crohn’s disease may be judiciously dilated to allow for endoscopic evaluation of recurrence or technical problems from the original resection. Dysplasia and carcinoma at colonic strictures cannot always be detected preoperatively.35 The stricture must be able to be traversed, adequately examined, and biopsied. Even then, the risk of sampling error in a stricture

can be high; a biopsied portion may demonstrate inflammation and fail to show deeper malignancy. If malignancy cannot be excluded, oncologic resection is indicated. In UC, proctocolectomy is the only means to definitively diagnose or rule out carcinoma and to treat possible multifocal malignancy, and should be considered in the management of colonic UC stricture. Unlike UC, a segmental oncologic resection may be appropriate in Crohn’s disease colorectal Inositol monophosphatase 1 stricture in a patient with limited segmental disease. Identification and treatment of dysplasia and colorectal cancer in IBD creates management challenges for the clinician. Treatment options for patients must be based on the understanding of differences in virulence between sporadic adenomas and inflammatory related dysplasia in patients with IBD. Surgical interventions should be based on patient morbidities, location and type of inflammation, and, most importantly, findings of dysplasia. Although the gold standard for oncologic resection is total proctocolectomy, many appropriate options exist that allow for intestinal continuity.