Outcomes of endoscopic submucosal dissection for high-risk colorectal colitis-associated neoplasia in inflammatory bowel disease

Roberta Maselli; Roberto de Sire; Federico Barbaro; Paolo Cecinato; Gianluca Andrisani; Erik Rosa-Rizzotto; Sandro Sferrazza; Giancarla Fiori; Francesco Azzolini; Francesco Pugliese; Antonio Facciorusso; Marco Spadaccini; Antonio Capogreco; Davide Massimi; Ludovico Alfarone; Michele Francesco Chiappetta; Alessandro Gubbiotti; Maddalena Menini; Kareem Khalaf; Romano Sassatelli; Francesco Maria Di Matteo; Cristiano Spada; Cesare Hassan; Alessandro Repici; Alessandro Armuzzi; on behalf of Endoscopic Resection Italian Network (ERIN) Group

doi:10.1055/a-2524-3553

Endoscopy, Table of Contents

Endoscopy 2025; 57(06): 658-666
DOI: 10.1055/a-2524-3553

Original article

Outcomes of endoscopic submucosal dissection for high-risk colorectal colitis-associated neoplasia in inflammatory bowel disease

Roberta Maselli

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

,

Roberto de Sire

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

³IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy

,

Federico Barbaro

⁴Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

,

Paolo Cecinato

⁵Digestive Endoscopy Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy

⁶Gastroenterology and Digestive Endoscopy, Azienda USL di Reggio Emilia, IRCCS, Reggio Emilia, Italy

,

Gianluca Andrisani

⁷Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy

,

Erik Rosa-Rizzotto

⁸Gastroenterology Unit, St. Anthony Hospital, Azienda Ospedale-Università, Padua, Italy

,

Sandro Sferrazza

⁹Gastroenterology and Endoscopy Unit, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy

,

Giancarla Fiori

¹⁰Endoscopy Unit, Istituto Europeo di Oncologia, IRCCS, Milan, Italy

,

Francesco Azzolini

¹¹Gastroenterology and Gastrointestinal Endoscopy Unit, San Raffaele Scientific Institute, IRCCS, Milan, Italy

,

Francesco Pugliese

¹²Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy

,

Antonio Facciorusso

¹³Gastroenterology Unit, Department of Experimental Medicine, University of Salento, Lecce, Italy

¹⁴Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.

,

Marco Spadaccini

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

,

Antonio Capogreco

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

,

Davide Massimi

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

,

Ludovico Alfarone

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

,

Michele Francesco Chiappetta

⁴Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

,

Alessandro Gubbiotti

⁸Gastroenterology Unit, St. Anthony Hospital, Azienda Ospedale-Università, Padua, Italy

,

Maddalena Menini

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

,

Kareem Khalaf

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

¹⁵Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada

,

Romano Sassatelli

⁶Gastroenterology and Digestive Endoscopy, Azienda USL di Reggio Emilia, IRCCS, Reggio Emilia, Italy

,

Francesco Maria Di Matteo

⁷Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy

,

Cristiano Spada

⁴Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

,

Cesare Hassan

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

,

Alessandro Repici

¹Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

,

Alessandro Armuzzi

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy

¹⁶Gastroenterology, IBD Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy

,

on behalf of Endoscopic Resection Italian Network (ERIN) Group

› Author Affiliations

Abstract

Background Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer. High-risk colorectal colitis-associated neoplasia (HR-CAN) can be difficult to treat using traditional endoscopic resection methods. This study evaluated the outcomes of endoscopic submucosal dissection (ESD) in patients with IBD and HR-CANs.

Methods This retrospective multicenter study consecutively included patients with IBD who were referred to expert Italian endoscopy centers for ESD or hybrid ESD (hESD) of HR-CANs. The main outcomes were rates of en bloc, R0, and curative resections, adverse events, local recurrence, metachronous lesions, and post-resection surgery. Kaplan–Meier method was used to analyze survival rates. Risk factors associated with the main outcomes were investigated by univariable analysis.

Results 91 patients with colonic IBD (disease duration 15.3 [SD 8.7] years, 82.4 % with ulcerative colitis) with 96 HR-CANs (mean size 34.8 [SD 16.2] mm, 53.1 % high grade dysplasia/adenocarcinoma) were included. ESD and hESD were performed in 82.3 % and 17.7 %, respectively. En bloc, R0, and curative resections were achieved in 95.8 % (95 %CI 89.6–98.8), 85.4 % (95 %CI 76.7–91.7), and 83.3 % (95 %CI 74.3–90.1). Adverse events occurred in 12.5 % (95 %CI 6.6–20.8), which were all conservatively managed. After a mean follow-up of 23.4 (SD 16.1) months, local recurrence and metachronous lesions each occurred in 3.1 %. Post-resection surgery was required in 11.5 %.

Conclusions ESD of HR-CANs showed favorable outcomes on the medium- and long-term course in patients with IBD.

Full Text

References

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Supplementary Material

Supplementary material