Endoscopic Submucosal Dissection for Colitis-Associated Dysplasia

Abstract

Dysplasia is a precancerous lesion of colorectal cancer in patients with long-standing inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn’s disease. Recent guidelines suggest endoscopic resection as a key modality for the treatment of endoscopically resectable dysplasia in patients with colitis. Endoscopic submucosal dissection (ESD) has been suggested as one of the therapeutic options for dysplasia that is potentially resectable but not suitable for the conventional endoscopic mucosal resection technique. Several recent studies supported the feasibility of ESD for the treatment of colitis-associated dysplasia in terms of the en bloc and complete resection rates and the risk of procedure-related complications. However, these studies were performed exclusively in expert centers. Moreover, the local and metachronous recurrence rates were relatively high, and long-term outcome data are still lacking. Endoscopists should be highly skilled in colorectal ESD and have an intensive understanding of not only the lesions but also the conditions of patients with IBDs. Therefore, the decision to perform ESD for colitis-associated dysplasia should be made scrupulously after careful discussion with patients, in collaboration with a multidisciplinary IBD team including physicians, surgeons, and pathologists specialized in IBDs.

An endoscopic treatment strategy for superficial tumors in patients with ulcerative colitis

“…When we undertake piecemeal resections during EMR, we carefully evaluate the stump of the ulcer, and additional mucosal cautery trimming is performed, where necessary, which may reduce the risk of local recurrence. While local recurrence (0%–22.2%) and R0 resection rates (77%–80%) have been reported following ESD of tumors in patients with UC, 9,11,12,21,30 our lower local recurrence rate corresponded with a higher R0 resection rate (97%) compared with those reported previously.…”

“…In this study, we found that ESD was more effective than EMR with respect to the overall R0 and curative resection rates for tumors in patients with UC, despite the presence of significantly larger and more non‐polypoid lesions in the ESD group. Previous studies' findings have shown that the en bloc and R0 resection rates for ESD in patients with UC were 80–100% and 76–80%, respectively, 9–12,21 for tumors with median sizes of 15–33 mm, of which approximately 80% had non‐polypoid morphologies. Our results were similar to these findings, and they supported the feasibility of ESD for tumors that are difficult to be treated using EMR in patients with UC.…”

Endoscopic molecular imaging in inflammatory bowel disease

“…3 shows that the techniques and equipment used for en- www.irjournal.org doscopic submucosal dissection (ESD) for sporadic colorectal neoplasia is also applicable to UC-associated dysplasia. 29 To make this possible, the endoscopic specialist must be highly trained in colorectal ESD, taking into account the lesions and the current condition of the IBD patients. In this section, we introduce and summarize the molecular pathobiology of CAC, the current guidelines, and the latest international consensus statement for detection and management of CAC.…”

“…Fig. 3 shows that the techniques and equipment used for endoscopic submucosal dissection (ESD) for sporadic colorectal neoplasia is also applicable to ulcerative colitis (UC)-associated dysplasia [ 29 ]. To make this possible, the endoscopic specialist must be highly trained in colorectal ESD, taking into account the lesions and the current condition of the IBD patients.…”

“…The final histology revealed low-grade dysplasia (42×40 mm in size, with clear lateral and vertical margins). Adapted from Yang DH, et al Clin Endosc 2019;52:120-128 [ 29 ].…”