ENDOSCOPIC SUBMUCOSAL DISSECTION IN IBD PATIENT: WHERE ARE WE?

Aims ESD of neoplastic lesions in IBD patients remains controversial. Data are very limited, with recent, retrospective series, exclusively limited to UC patients. The aim of this study is to clarify the contribution of ESD in IBD patients in terms of curative endoscopic resection. Secondary objectives are rate of complications, technical success, and endoscopic follow-up.

Methods Experts French centers in ESD are prospectively recording all of their endoscopic procedures. Retrospectively, we identified 28 IBD patients treated with a colorectal ESD in 7 centers, representing 34 cases. Data were collected from 21 patients until now.

Results 25 ESD were included in 21 IBD patients (12 CD/9 UC). Lesions were located mainly on the rectum (60%), and were LST-G (52.6%), LST-NG (42.1%) or pediculated (5.2%), with a mean size of 44.5 ± 19mm. The mean duration of ESD was 80.5min. The final histology showed 19 LGD, 5 HGD. Monobloc resection and R0 resection were respectively obtained in 95.8% (23/24) and 75% (18/24) of the cases, due to positive lateral margins in 6 patients in LGD. The overall rate of curative endoscopic resection was 75%. There was 1 haemorrhagic complication, and 1 case of perforation operated. During endoscopic FU, 4 patients presented a metachronous neoplastic lesion, including 3 LGD site-specific recurrences (2 patients had anterior R0 resection), 1 case of distant neoplastic lesion. Mucosal fibrosis was noted in 63% (F2), allowing exclusive ESD.

Conclusions This is the first series of ESD in IBD patient including CD. It´s technically feasible, with no risk of complication compared to a standard population, in an expert center, with curative endoscopic resection in 75%. The difficult technical points are a difficult lateral margin delineation and mucosal fibrosis. Endoscopic FU is fundamental, to allow the detection of metachronous lesions, even in R0 patients.