This document summarizes a journal club discussion on colorectal cancer (CRC) as a complication of inflammatory bowel diseases (IBDs). It notes that improvements in disease management and endoscopic technology have changed how IBD-related dysplasia is conceptualized and managed. The discussion proposes a conceptual model and best practice advice to be used alongside evolving literature and guidelines for shared decision making. It concludes that endoscopic inspection and targeted biopsies using new technologies are increasingly preferred over nonspecific biopsies or colectomy for low-grade dysplasia, with endoscopic resection of visible lesions and surgery reserved for high-risk cases. More data is still needed on several aspects.

1. Kurdistan Board GEH/GIT Surgery J Club 2021
Supervised by Professor Dr. Mohamed Alshekhani.

2. Introduction:
 CRC has been one of the most feared complications of IBDs.
 Not long ago, notions of imperceptible CRC development & urgent need
for colectomy in the face of dysplasia dominated IBD practice.
 Improvements in disease management&endoscopic technology/quality,
have dramatically changed the way in which we conceptualize & manage
IBD-related dysplasia over the past 20 years.
 The proposed conceptual model & best practice advice statements in this
review are best used in conjunction with evolving literature& existing
societal guidelines as part of a shared decision-making process.

11. Conclusion:
 Improvements in disease management,endoscopic technology & quality,
have dramatically changed the way in which we think about IBD-related
dysplasia, aligning closely with how we conceptualize dysplasia in the non-
IBD population.
 The practices of taking nontargeted biopsies&of referring patients for
colectomy in the setting of low-grade or invisible dysplasia are being
increasingly challenged in favor of “smart” approaches by careful
inspection & targeted sampling of visible& subtle lesions using newer
technologies (including HD-WLE& DCE),endoscopic management of most
endoscopically resectable lesions ,with surgery increasingly reserved for
lesions harboring strong risk factors for invasive cancer or when
endoscopic clearance is not possible.
 More data required for the role of nontargeted biopsies when using HD
scopes, the long-term safety of endoscopic management of large/ complex
dysplastic lesions& the optimal surveillance intervals considering lifetime
inflammatory burden& other CRC risk factors.