Dysplasia in Endoscopy: Is It Cancer?
A clear and reassuring guide to understand what dysplasia means, when to worry, and what treatments exist according to the latest European guidelines
Understanding dysplasia: the step between normal cells and cancer
Quick Summary - The Essentials
🎯 Most important:
- • Dysplasia is NOT cancer yet, but it's an important warning
- • It's an "early alarm" that allows us to act before cancer develops
- • Treatment is almost always endoscopic (no surgery)
- • Detecting and treating it prevents cancer in over 95% of cases
📊 What you should know:
- • There are two grades: low (less urgent) and high (more urgent)
- • Location matters: Barrett's, stomach, or colon
- • Management varies according to type and location
- • Surveillance and treatment are well-protocolized
First of all: Take a deep breath
Dysplasia in endoscopy means we've detected cells that are changing abnormally. No, it's not cancer yet. It's like finding a warning sign on the road before the actual danger. The great news is that detecting it now gives us time to act and prevent it from becoming cancer. In fact, by treating it properly, we can prevent cancer in over 95% of cases.
What exactly is dysplasia in endoscopy?
Imagine that the cells in your digestive tract are like bricks in a wall. Normally, all the bricks are perfectly placed, the same size, and well-ordered. Dysplasia in endoscopy is when some of these "bricks" start to look different: some larger, others with strange shapes, some misplaced.
It's important to understand that dysplasia in endoscopy is NOT cancer. It's more like an "alert state" of the cells. They are changing, yes, but they haven't yet made the leap to becoming cancer. That's why we call it a precancerous lesion.
Think of it this way
If cancer were a red traffic light, dysplasia would be the yellow light. We're not in immediate danger, but it's time to slow down and act with caution. The advantage is that detecting dysplasia gives us the perfect opportunity to intervene before the "red" arrives.
The two levels of dysplasia: low and high grade
Not all dysplasias are the same. Pathologists (the medical specialists who analyze biopsies under the microscope) classify them into two main categories:
Low-Grade Dysplasia (LGD)
The changes in the cells are mild. It's as if the "bricks" were slightly out of place, but not much.
• Slow progression toward cancer
• Time to plan treatment
• Sometimes close surveillance, sometimes treatment
• Risk of progression: 10-15% in 5 years
High-Grade Dysplasia (HGD)
The changes are more severe. The "bricks" are quite disorganized and with very abnormal shapes.
• Needs treatment sooner
• Higher risk of progressing to cancer
• Generally requires endoscopic resection
• Up to 30-50% already has associated microscopic cancer
Have they detected dysplasia and need an expert?
As a specialist in advanced endoscopy, I can evaluate your case and offer you the most appropriate treatment according to the latest European guidelines.
Book an AppointmentVisual Guide: What to Do According to Location?
Each area of the digestive tract has its own protocol. Here I explain it in a simple and visual way so you can understand it at a glance:
Stomach
Generally associated with chronic gastritis or intestinal metaplasia
Action Plan
Surveillance at 6-12 months (first follow-up)
If dysplasia persists: ESD (any size)
💡 Key: ESD is the technique of choice in stomach
Action Plan
ESD mandatory (standard technique)
En bloc resection (single piece)
Complete analysis by pathologist
⚠️ Important: EMR only in very selected cases (<10mm elevated)
Why ESD in stomach?
ESD allows obtaining the entire lesion in one piece, which gives complete information to the pathologist about whether there is deep invasion and dramatically reduces recurrences (lesion reappearance).
Follow-up
Endoscopy at 3-6 months, then annual with high definition and chromoendoscopy. Learn more about atrophic gastritis cancer risk.
Colon and Rectum
Adenomatous polyps with dysplasia
📋 ESGE 2024 Recommendations Summary
Small polyps (≤9mm): Cold snare polypectomy
Medium polyps (10-19mm): Hot snare polypectomy
Large lesions (≥20mm): Conventional EMR + mandatory thermal ablation of margins if fragmented resection
With suspected invasion: En bloc ESD (expert centers)
Colon in General
According to Size
Cold snare: Simple and safe technique
Hot snare: Cutting with controlled energy
EMR + ablation: Resection + burn edges
💡 Remember: Thermal ablation of margins is mandatory in lesions ≥20mm if fragmented resection
⚠️ Rectum: Special Attention
🎯 KEY IN RECTUM
Lesions >20mm have HIGHER RISK of malignancy than in colon
ESD Recommendation
Rectal lesions >20mm: Consider ESD
Advantage: Complete en bloc resection
Result: Better staging, fewer recurrences
⚠️ Why: The rectum has special anatomy and higher risk of hidden cancer in large lesions
Follow-up
Lesions ≥20mm: Colonoscopy at 6 months, if negative at 1 year, then every 3-5 years. Learn more about when to choose EMR or ESD in colon polyps.
Treatment options: Almost everything is done by endoscopy
The great news is that most dysplasias are treated with endoscopy, without the need for major surgery. There are several techniques depending on the type, size, and location of the lesion:
Endoscopic Mucosal Resection (EMR)
The lesion is "lifted" with a liquid injection underneath and cut with an electric snare. It's like removing a stamp from a letter after wetting it.
• Barrett's: lesions ≤20 mm without invasion
• Colon: lesions ≥20 mm without deep invasion
• Stomach: only very selected lesions <10mm
Endoscopic Submucosal Dissection (ESD)
Advanced technique that allows removing the entire lesion in one piece, even if it's very large. It's "dissected" layer by layer with millimeter precision.
• Stomach: ALL dysplasia (technique of choice)
• Barrett's: lesions >20mm or with invasion
• Colon/rectum: lesions >20mm with suspected invasion
See real clinical cases
Radiofrequency Ablation (RFA)
Controlled energy is applied that superficially "burns" the abnormal mucosa. Technique specific to Barrett's.
• Low-grade dysplasia in Barrett's (primary treatment)
• Flat high-grade dysplasia in Barrett's
• Residual Barrett's after lesion resection
Simple Polypectomy
For small colonic polyps with dysplasia, they are simply cut with cold snare (≤9mm) or hot (10-19mm).
• Colonic polyps ≤19 mm with low-grade dysplasia
• Fast, safe and effective technique
Advantages of endoscopic treatment
- • No major surgery: No external incisions or scars
- • Quick recovery: Hospital discharge in 1-2 days (or same day in simple cases)
- • Fewer complications: Much lower risks than surgery
- • Organ preservation: The esophagus, stomach or colon is completely preserved
- • High cure rate: >95% in lesions without deep invasion
- • Complete histological analysis: Especially with ESD, allows accurate staging
Need advanced endoscopic treatment for dysplasia?
With over 10 years of experience in endoscopic resection techniques, including specialized training in Japan, I can offer you the most appropriate treatment according to your specific case.
Book an AppointmentWhat happens after treatment? The prognosis is excellent
Once dysplasia is properly treated, the prognosis is excellent. Data from the most recent European guidelines show us:
Complete cure rate
95-98% of dysplasias treated endoscopically do not reappear if completely eliminated. In Barrett's treated with ablation after EMR/ESD, the complete remission rate exceeds 90%.
Manageable recurrences
If any recurrence appears (2-15% depending on location and technique), it's almost always small and can be successfully treated again by endoscopy. ESD has lower recurrence rates than piecemeal EMR. That's why follow-up is so important.
Effective cancer prevention
Treating dysplasia in time reduces cancer risk by more than 95%. It's one of the most effective medical interventions that exist to prevent digestive cancer.
Final message: Dysplasia is an opportunity, not a sentence
Remember the most important thing
Finding dysplasia in endoscopy is detecting the problem BEFORE it becomes cancer. It's your opportunity to act in time.
As a specialist in advanced endoscopy with international training in Japan and Europe, I have treated hundreds of cases of dysplasia with minimally invasive techniques. The key is accurate diagnosis, choosing the appropriate technique for each case (EMR, ESD or ablation according to location and characteristics), and maintaining rigorous follow-up.
If you have been diagnosed with dysplasia, you are not alone. It's a well-known and protocolized path, with excellent results when managed correctly. Modern medicine allows us to intervene at that exact moment between "normal" and "cancer," saving lives without major surgeries.
Have they detected dysplasia in endoscopy?
I can evaluate your case personally and offer you the best treatment according to the most updated European guidelines (ESGE 2022-2024).
Book an AppointmentScientific References
- 1. Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy. 2022;54:591-622. Link to ESGE ESD 2022 guideline
- 2. Weusten BLAM, Bisschops R, Dinis-Ribeiro M, et al. Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2023;55:1124-1166. Link to ESGE Barrett's 2023 guideline
- 3. Ferlitsch M, Hassan C, Bisschops R, et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024. Endoscopy. 2024;56:560-597. Link to ESGE Polyps 2024 guideline
Dr. Pedro de María Pallarés
Specialist in Digestive Diseases • Expert in Advanced Endoscopy
Hospital Universitario La Paz • INMEQ
🏆 TopDoctors Awards 2024 • Member SEPD, SEED, ESGE