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

Saowanee Ngamruengphong; Hiroyuki Aihara; Shai Friedland; Makoto Nishimura; David Faleck; Petros Benias; Dennis Yang; Peter V. Draganov; Nikhil A. Kumta; Zachary A. Borman; Rebekah E. Dixon; James F. Marion; Lionel S. DʼSouza; Yutaka Tomizawa; Simran Jit; Sonmoon Mohapatra; Aline Charabaty; Alyssa Parian; Mark Lazarev; Esteban J. Figueroa; Yuri Hanada; Andrew Y. Wang; Louis M. Wong Kee Song

doi:10.1055/a-1783-8756

Endoscopy International Open, Table of Contents

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‡

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Hiroyuki Aihara‡

²Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Maryland, United States

,

Shai Friedland

³Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, United States

,

Makoto Nishimura

⁴Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States

,

David Faleck

⁴Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States

,

Petros Benias

⁵Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States

,

Dennis Yang

⁶Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States

,

Peter V. Draganov

⁶Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States

,

Nikhil A. Kumta

⁷Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Zachary A. Borman

⁷Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Rebekah E. Dixon

⁷Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

James F. Marion

⁷Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Lionel S. DʼSouza

⁸Division of Gastroenterology and Hepatology at Stony Brook School of Medicine, Stony Brook, New York, United States

,

Yutaka Tomizawa

⁹Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington, United States

,

Simran Jit

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Sonmoon Mohapatra

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Aline Charabaty

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Alyssa Parian

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Mark Lazarev

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Esteban J. Figueroa

¹⁰Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States

,

Yuri Hanada

¹¹Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States

,

Andrew Y. Wang

¹⁰Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States

,

Louis M. Wong Kee Song

¹¹Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States

› Author Affiliations

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.

Full Text

References

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