Comparative outcomes of endoscopic mucosal resection for laterally spreading lesions in inflammatory bowel disease

Abstract

Background The role of endoscopic mucosal resection (EMR) for laterally spreading lesions (LSLs) in inflammatory bowel disease (IBD) remains controversial despite its effectiveness in the general population. We aimed to characterize outcomes of EMR for IBD-associated LSLs compared with controls without IBD.

Methods We performed a retrospective observational cohort study of patients with IBD who underwent EMR and endoscopic follow-up for LSLs, compared with a control group without IBD. The primary outcome was histologic recurrence. Secondary outcomes included en bloc resection and adverse events. Factors associated with recurrence were identified using multivariate mixed effects logistic regression.

Results 210 premalignant lesions in 155 patients were included. By histology, 91.0% were adenoma/low grade dysplasia or sessile serrated lesions. Median (IQR) lesion size was 25 (12–30) mm in the IBD group and 20 (12–30) mm in the control group. Recurrence was detected in 30.4% of IBD-associated lesions (7/23) compared with 20.9% of controls (39/187; odds ratio [OR] 2.51, 95%CI 0.59–10.71). En bloc resection was less common in the IBD group (2/23 [8.7%], 95%CI 1.1–28.0) versus controls (106/187 [56.7%], 95%CI 50.4–65.2). After adjusting for lesion size and histology, recurrence appeared more common in patients with IBD compared with controls (OR 3.08, 95%CI 1.04–9.13).

Conclusions Recurrence of LSLs after EMR appeared to be more frequent in patients with IBD. Given the added complexity, EMR in patients with IBD should be performed in expert centers with close endoscopic surveillance.

Publication History

Received: 27 October 2023

Accepted after revision: 19 July 2024

Accepted Manuscript online:
19 July 2024

Article published online:
18 September 2024

• References

• 1 Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48: 526-535
• 2 Herrinton LJ, Liu L, Levin TR. et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382-389
• 3 Cairns SR, Scholefield JH, Steele RJ. et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-689
• 4 Ullman TA, Itzkowitz SH. Intestinal inflammation and cancer. Gastroenterology 2011; 140: 1807-1816
• 5 Laine L, Kaltenbach T, Barkun A. et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc 2015; 81: 489-501.e426
• 6 Alexandersson B, Hamad Y, Andreasson A. et al. High-definition chromoendoscopy superior to high-definition white-light endoscopy in surveillance of inflammatory bowel diseases in a randomized trial. Clin Gastroenterol Hepatol 2020; 18: 2101-2107
• 7 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
• 8 East JE, Toyonaga T, Suzuki N. Endoscopic management of nonpolypoid colorectal lesions in colonic IBD. Gastrointest Endosc Clin N Am 2014; 24: 435-445
• 9 Murthy SK, Feuerstein JD, Nguyen GC. et al. AGA clinical practice update on endoscopic surveillance and management of colorectal dysplasia in inflammatory bowel diseases: expert review. Gastroenterology 2021; 161: 1043-1051.e1044
• 10 Belderbos TD, Leenders M, Moons LM. et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46: 388-402
• 11 Klein A, Tate DJ, Jayasekeran V. et al. Thermal ablation of mucosal defect margins reduces adenoma recurrence after colonic endoscopic mucosal resection. Gastroenterology 2019; 156: 604-613.e603
• 12 Mangira D, Raftopoulos S, Vogrin S. et al. Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for nonpedunculated colorectal polyps of 10–19  mm: a multicenter observational cohort study. Endoscopy 2023; 55: 627-635
• 13 Chandan S, Khan SR, Kumar A. et al. Efficacy and histologic accuracy of underwater versus conventional endoscopic mucosal resection for large (>20 mm) colorectal polyps: a comparative review and meta-analysis. Gastrointest Endosc 2021; 94: 471-482.e479
• 14 Dumoulin FL, Hildenbrand R. Endoscopic resection techniques for colorectal neoplasia: current developments. World J Gastroenterol 2019; 25: 300-307
• 15 Fukami N. Surgery versus endoscopic mucosal resection versus endoscopic submucosal dissection for large polyps: making sense of when to use which approach. Gastrointest Endosc Clin N Am 2019; 29: 675-685
• 16 Chen W, Zhang YL, Zhao Y. et al. Endoscopic resection for non-polypoid dysplasia in inflammatory bowel disease: a systematic review and meta-analysis. Surg Endosc 2021; 35: 1534-1543
• 17 Hurlstone DP, Sanders DS, Atkinson R. et al. Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: can we change the endoscopic management paradigm?. Gut 2007; 56: 838-846
• 18 Yadav S, Loftus Jr EV, Harmsen WS. et al. Outcome of endoscopic resection of colonic polyps larger than 10 mm in patients with inflammatory bowel disease. Endosc Int Open 2019; 7: E994-e1001