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adenoma-like DALMs

Sunday 2 December 2012

Synopsis

- adenoma-like DALMs represent well-circumscribed, smooth or papillary, nonnecrotic, sessile, or pedunculated polyps.

- adenoma-like DALMs are usually easily removed by routine endoscopic methods, similar to sporadic adenomas.

- adenoma-like DALMs possess a low risk of malignancy and, as a result, may be treated conservatively by polypectomy and continued surveillance.

- The adenoma-like DALMs in UC represent 2 types of lesions:

  • The first are "sporadic adenomas" that occur coincidentally in patients with UC, and, thus, are etiologically unrelated to the underlying inflammatory disease. Sporadic adenomas may develop in both inflamed and noninflamed portions of the bowel.
  • Adenoma-like lesions that occur within noninflamed portions of the bowel (i.e., proximal to areas of chronic colitis) are easy to diagnose as sporadic adenomas since dysplasia and cancer in UC is believed to develop as a direct result of the underlying inflammatory condition.

- adenoma-like DALMs located outside, or proximal to, areas of known colitis may be assumed to be sporadic in origin and, thus, treated conservatively by polypectomy and continued surveillance similar to patients with sporadic adenomas but without UC.

- UC patients with an adenoma-like DALM located within an area of colitis may also be treated conservatively by polypectomy and continued surveillance if the lesion has been excised completely by endoscopy, shows an absence of dysplasia at the margins of the specimen, and there is no evidence of flat dysplasia elsewhere in the colon either adjacent to or distant from the polypoid lesion.

Open References

- What are the guidelines for treating adenoma-like DALMs in UC? Robert D. Odze MD, FRCP(c); 24 SEP 2008 http://onlinelibrary.wiley.com/doi/10.1002/ibd.20647/full (Free)