Aims:
In patients with ulcerative colitis (UC), sporadic neoplasms (SN) can also occur in addition to UC-associated colorectal cancer/dysplasia (UCAC). Recently, reports on endoscopic submucosal dissection (ESD) for UCAC and SN have been published. However, there is no consensus regarding ESD. We retrospectively evaluated the feasibility and safety of ESD for UCAC and SN.
Methods:
The subjects were 32 patients with 33 lesions who met the following criteria: diagnosed with a UC associated lesion; were in the remission phase and had well-circumscribed, single lesions with no dysplasia in the periphery. A comparative investigation by propensity score matching analysis was performed for investigating the
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ESD treatment outcome, and
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difference in treatment outcomes between the UC-ESD group (n = 33) and non-UC-ESD group (control: n = 751).
Results:
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The rate of en bloc resection by ESD was 97%, R0 resection rate was 81.8%, mean tumour diameter was 28.4 mm, and mean procedure time was 70.6 min. The adverse events were perforation in 2 patients, and postoperative bleeding in 1 patient. Based on histopathological investigations after ESD, SN was confirmed in 25 lesions and UCAC was confirmed in 8 lesions. All the lesions suspected of being SN were indeed SN.
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Using the propensity score matching analysis, 29 pairs were matched. Comparing treatment outcomes between the 2 groups, mean surgery time was significantly longer in the UC-ESD group (p = 0.0261). With respect to adverse events, although no significant difference was seen, the adverse events occurred only in the UC-ESD group.
Conclusions:
ESD for lesions with UC was feasible and safety. ESD is recommended as an optimal treatment for en bloc excision and accurate pathological diagnosis. However, compared to non-UC-ESD, UC-ESD is very difficult due to severe fibrosis. For these reasons, UC-ESD should be required to be performed by expert who has endoscopic technique both diagnosis and treatment.
