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Question A 50 years old Male known with a diagnosis of ulcerative colitis since October 2012 (Montreal Class E3) was seen for further follow up in gastroenterology outpatient. He was on Meselazine 2.4 gm per day. The last flare up he had was 2.5 years ago in April 2013 when he was treated successfully with a course of oral steroids. His colitis has been in a stable state with no further flare ups ever since. During his follow-up in Gastroenterology clinic in Sept 2015, he mentioned that he is opening his bowels 4-5/day with a consistency between watery to loose stool that was “normal” for him. He denied having significant bleeding or cramps. He also denied having a family history for colorectal cancer (CRC) or polyps. Physical examination was unremarkable. Blood test revealed a normal CRP of 7, FBC, LFTs and U &E were also normal. Further colonoscopy surveillance were organised for assessment. What is the diagnosis? What is the prognosis and appropriate management? Figure 1 Colonoscopy; distal ascending colon. The colonoscopist reported that the ascending abnormalities caused stenosis but just enough open to pass the scope getting through to the Caecum  Answer Giant Inflammatory Polyps (GIPs) in IBD.

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