The issue of dysplasia within the setting of chronic colitis is rapidly evolving, and more aggressive endoscopic management and surveillance is clearly being suggested in selected cases (1–3). With the advent of more effective therapies such as tumour necrosis factor inhibitors, it has been suggested that some patients are likely to be managed with medical therapy for longer time periods (before colectomy), possibly resulting in an increased lifetime risk of dysplasia due to the retained colon. Although suppotive data for this hypothesis are lacking, there are several new studies that have improved our knowledge in these areas and may lead to increased endoscopic management of certain colonic lesions in this setting. The cumulative risk of colon cancer in patients with colitis has been an epidemiological debate for many years (4–6). In ulcerative colitis (UC), Eaden et al (7,8) demonstrated a risk of almost 20% at 25 years, giving support to the possibility of early prophylactic colectomy. Others have argued that in an era of more effective medical therapy and more intense patient monitoring, this number may be decreased because inflammation is one of the key risk factors for dysplasia, and by treating the colitis more aggressively, dysplasia risks may be decreased although duration of disease is increased. Dr Brian Bressler is a gastroenterologist and clinical instructor at St Paul’s Hospital and the University of British Columbia, Vancouver, British Columbia