Endoscopic Evaluation of Inflammatory Bowel Disease With High-Grade Dysplasia Should Not Be Delayed During the COVID-19 Pandemic: A Case Report

摘要

A 63-year-old woman with long-standing ulcerative colitis was found by routine, high-definition white light surveillance colonoscopy to have high-grade dysplasia (HGD) on a random biopsy of flat, erythematous mucosa of the rectosigmoid colon. Several previous surveillance colonoscopies had consistently shown mild-moderate pancolitis and pseudopolyposis without dysplasia. The patient's bowel complaints were moderately controlled by oral mesalamine, with multiple previous refusals to escalate therapy to achieve mucosal healing. After a second gastrointestinal pathologist review confirming HGD, the case was discussed at our institution's multidisciplinary inflammatory bowel disease (IBD) conference, after which the patient was offered colectomy. The patient, however, refused and was referred to the advanced endoscopy service for chromoendoscopy and possible endoscopic resection. Shortly after the referral, the novel coronavirus disease 2019 (COVID-19) pandemic arose, and the patient chose to postpone her colonoscopy by 3 months because of the fear of contracting the novel coronavirus. When it was finally performed, a new 3 cm sessile lesion (Paris class IIb) in the rectosigmoid colon was identified (Figure ). It was removed via endoscopic mucosal resection with snare tip coagulation of the resection border. Pathology revealed moderately differentiated adenocarcinoma. The patient was referred to colorectal surgery for colectomy.