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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E354-E360
DOI: 10.1055/a-1783-8756
Original article

Endoscopic submucosal dissection for colorectal dysplasia in inflammatory bowel disease: a US multicenter study

Saowanee Ngamruengphong‡
 1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Hiroyuki Aihara‡
 2   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Maryland, United States
,
Shai Friedland
 3   Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, United States
,
Makoto Nishimura
 4   Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States
,
David Faleck
 4   Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States
,
Petros Benias
 5   Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States
,
Dennis Yang
 6   Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
,
Peter V. Draganov
 6   Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
,
Nikhil A. Kumta
 7   Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Zachary A. Borman
 7   Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Rebekah E. Dixon
 7   Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
James F. Marion
 7   Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Lionel S. DʼSouza
 8   Division of Gastroenterology and Hepatology at Stony Brook School of Medicine, Stony Brook, New York, United States
,
Yutaka Tomizawa
 9   Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington, United States
,
Simran Jit
 1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Sonmoon Mohapatra
 1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Aline Charabaty
 1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Alyssa Parian
 1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mark Lazarev
 1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Esteban J. Figueroa
10   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
,
Yuri Hanada
11   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Andrew Y. Wang
10   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
,
Louis M. Wong Kee Song
11   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Background and study aims In patients with inflammatory bowel disease (IBD), endoscopically visible lesions with distinct borders can be considered for endoscopic resection. The role of endoscopic submucosal dissection (ESD) for these lesions is not well defined because of a paucity of data. We aimed to evaluate the outcomes of colorectal ESD of dysplastic lesions in patients with IBD across centers in the United States.

Patients and methods This was a retrospective analysis of consecutive patients with IBD who were referred for ESD of dysplastic colorectal lesions at nine centers. The primary endpoints were the rates of en bloc resection and complete (R0) resection. The secondary endpoints were the rates of adverse events and lesion recurrence.

Results A total of 45 dysplastic lesions (median size 30mm, interquartile range [IQR] 23 to 42 mm) in 41 patients were included. Submucosal fibrosis was observed in 73 %. En bloc resection was achieved in 43 of 45 lesions (96 %) and R0 resection in 34 of 45 lesions (76 %). Intraprocedural perforation occurred in one patient (2.4 %) and was treated successfully with clip placement. Delayed bleeding occurred in four patients (9.8 %). No severe intraprocedural bleeding or delayed perforation occurred. During a median follow-up of 18 months (IQR 13 to 37 months), local recurrence occurred in one case (2.6 %). Metachronous lesions were identified in 11 patients (31 %).

Conclusions ESD, when performed by experts, is safe and effective for large, dysplastic colorectal lesions in patients with IBD. Despite the high prevalence of submucosal fibrosis, en bloc resection was achieved in nearly all patients with IBD undergoing ESD. Careful endoscopic surveillance is necessary to monitor for local recurrence and metachronous lesions after ESD.



Publication History

Received: 23 April 2021

Accepted after revision: 17 January 2022

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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