The paradigm for surveilling and managing inflammatory bowel disease-associated colorectal dysplasia has changed as high-definition colonoscopy and chromoendoscopy have significantly improved the visualization of dysplasia, and endoscopic mucosal resection has made more lesions endoscopically resectable. However, these patients are at high risk of recurrent dysplasia and cancer and require intensive colonoscopic surveillance. Patients with invisible high-grade dysplasia, invisible multifocal low-grade dysplasia, and colorectal cancer should be considered for surgical resection. Total proctocolectomy removes all at-risk tissue. Subtotal colectomy with ileorectal anastomosis can be considered in select patients (ie, advanced age, poor functional status, and with no rectal inflammation or dysplasia).