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Endoscopy
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
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
Roberto de Sire
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
3   IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
,
Federico Barbaro
4   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
,
Paolo Cecinato 
5   Digestive Endoscopy Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
6   Gastroenterology and Digestive Endoscopy, Azienda USL di Reggio Emilia, IRCCS, Reggio Emilia, Italy
,
Gianluca Andrisani
7   Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
,
Erik Rosa-Rizzotto
8   Gastroenterology Unit, St. Anthony Hospital, Azienda Ospedale-Università, Padua, Italy
,
Sandro Sferrazza
9   Gastroenterology and Endoscopy Unit, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy
,
Giancarla Fiori
10   Endoscopy Unit, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
,
Francesco Azzolini
11   Gastroenterology and Gastrointestinal Endoscopy Unit, San Raffaele Scientific Institute, IRCCS, Milan, Italy
,
Francesco Pugliese
12   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
,
Antonio Facciorusso 
13   Gastroenterology Unit, Department of Experimental Medicine, University of Salento, Lecce, Italy
14   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
,
Marco Spadaccini
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
,
Antonio Capogreco 
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
,
Davide Massimi
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
,
Ludovico Alfarone
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
,
Michele Francesco Chiappetta
4   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
,
Alessandro Gubbiotti
8   Gastroenterology Unit, St. Anthony Hospital, Azienda Ospedale-Università, Padua, Italy
,
Maddalena Menini
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
Kareem Khalaf
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
15   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
,
Romano Sassatelli
6   Gastroenterology and Digestive Endoscopy, Azienda USL di Reggio Emilia, IRCCS, Reggio Emilia, Italy
,
Francesco Maria Di Matteo
7   Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
,
Cristiano Spada
4   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
,
Cesare Hassan
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
Alessandro Repici
1   Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
,
Alessandro Armuzzi
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
16   Gastroenterology, IBD Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
,
on behalf of Endoscopic Resection Italian Network (ERIN) Group › Author Affiliations
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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.

Supplementary Material



Publication History

Received: 25 May 2024

Accepted after revision: 23 January 2025

Accepted Manuscript online:
23 January 2025

Article published online:
24 February 2025

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