Endoscopic submucosal dissection for nonpolypoid colorectal dysplasia in patients with inflammatory bowel disease: in medias res

Soetikno, Roy; East, James E.; Suzuki, Noriko; Uedo, Noriya; Matsumoto, Takayuki; Watanabe, Kenji; Sanduleanu, Silvia; Sánchez-Yagüe, Andrés; Kaltenbach, Tonya

doi:10.1016/j.gie.2018.01.013

Cited by 27 publications

(20 citation statements)

References 28 publications

(39 reference statements)

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“…Dysplasia incidence rates were reported to have almost doubled from the 1993‐2002 to the 2003‐2012 time period in the St Mark's surveillance cohort 13 . Advanced dysplasia resection techniques such as endoscopic submucosal dissection and hybrid techniques have also allowed the resection of flat nonpolypoid lesions, previously destined for surgical management only 12,14 . However, the impact of these advances on rates of metachronous advanced neoplasia developing during surveillance follow‐up remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

Kabir

Fofaria

Arebi

et al. 2020

Aliment Pharmacol Ther

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Background Introduction The prognosis of dysplasia in patients with IBD is largely determined from observational studies from the pre‐videoendoscopic era (pre‐1990s) that does not reflect recent advances in endoscopic imaging and resection. Aims To better understand the risk of synchronous colorectal cancer and metachronous advanced neoplasia (ie high‐grade dysplasia or cancer) associated with dysplasia diagnosed in the videoendoscopic era, and to stratify risk according to a lesion's morphology, endoscopic resection status or whether it was incidentally detected on biopsy of macroscopically normal colonic mucosa (ie invisible). Methods A systematic search of original articles published between 1990 and February 2020 was performed. Eligible studies reported on incidence of advanced neoplasia at follow‐up colectomy or colonoscopy for IBD‐dysplasia patients. Quantitative and qualitative analyses were performed. Results Thirty‐three studies were eligible for qualitative analysis (five for the meta‐analysis). Pooled estimated proportions of incidental synchronous cancers found at colectomy performed for a pre‐operative diagnosis of visible high‐grade dysplasia, invisible high‐grade dysplasia, visible low‐grade dysplasia and invisible low‐grade dysplasia were 13.7% (95% CI 0.0‐54.1), 11.4% (95% CI 4.6‐20.3), 2.7% (95% CI 0.0‐7.1) and 2.4% (95% CI 0.0‐8.5) respectively. The lowest incidences of metachronous advanced neoplasia, for dysplasia not managed with immediate colectomy but followed up with surveillance, tended to be reported by the studies where high definition imaging and/or chromoendoscopy was used and endoscopic resection of visible dysplasia was histologically confirmed. Conclusions The prognosis of IBD‐dysplasia diagnosed in the videoendoscopic era appears to have been improved but the quality of evidence remains low. Larger, prospective studies are needed to guide management. PROSPERO registration no: CRD42019105736.

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Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

Kabir

Fofaria

Arebi

et al. 2020

Aliment Pharmacol Ther

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“…Several signs related to non-polypoid dysplasia were described in a recent paper, including interruption of innominate lines, wall deformity, spontaneous friability, shallow ulcer, velvety appearance, villous mucosa, slight discoloration, and “red in blue” sign during CE. 21 Most of these descriptors seem difficult to standardize, although the interobserver agreements for these features have not yet been investigated. Moreover, little is known about the diagnostic performance of these descriptors for predicting dysplasia, although the sensitivity and specificity of interrupted innominate lines were both reported as 56% in one study.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study

et al. 2020

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Background/Aims: Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endoscopic diagnosis of "nonpedunculated" dysplasia or colitic cancer in UC patients. Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologically confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy. Results:The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the intention to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, including ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI, 57.3% to 69.1%), respectively. Conclusions: Diagnostic per-formance based on the endoscopist's intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study. (Gut Liver,

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“…Chromoendoscopy was adopted into routine surveillance practice from 2003 onwards at St Mark's Hospital and true high-definition imaging processors have been available from 2012 onwards. The development of advanced endoscopic resection techniques of non-polypoid dysplasia such as endoscopic submucosal dissection (ESD) and hybrid ESD/endoscopic mucosal resection (EMR), have allowed a greater number of these lesions to be endoscopically resected, when previously they would have been consigned to colectomy surgery 15 . More recent case series and smaller cohort studies from centres where high definition chromoendoscopy surveillance and advanced endoscopic resection techniques have been used have demonstrated lower rates of truly invisible dysplasia detection and lower AN progression rates after dysplasia has been endoscopically resected [13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

“…However, the associations were based on historical data pre-dating the year 2000, which consequently do not necessarily reflect the endoscopic advances adopted into practice in the last two decades, such as high definition chromoendoscopy and endoscopic resection techniques, such as endoscopic submucosal dissection. These advances have been linked with lower rates of invisible dysplasia detection and lower AN progression rates [13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Multi-centre derivation and validation of a colitis-associated colorectal cancer risk prediction web-tool

Curtius

Kabir

Bakir

et al. 2020

Preprint

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Background and Aims Ulcerative colitis (UC) patients diagnosed with low-grade dysplasia (LGD) have increased risk of developing advanced neoplasia (AN; high-grade dysplasia or colorectal cancer). We aimed to develop and validate a predictor of AN risk in UC patients with LGD and create a visual web-tool to effectively communicate the risk. Methods In our retrospective multi-centre validated cohort study, adult UC patients with an index diagnosis of LGD, identified from four UK centres between 2001-2019, were followed until progression to AN. In the discovery cohort (n=248), a multivariate risk prediction model was derived from clinicopathological features using Cox regression. Validation used data from 3 external centres (n=201). The validated model was embedded in a web-based tool to calculate and illustrate patient-specific risk. Results Four endoscopic variables were significantly associated with future AN progression in the discovery cohort: endoscopically visible LGD > 1 cm (HR = 2.8; 95% CI 1.3-6.0), incomplete endoscopic resection (HR = 2.9; 95% CI 1.3-6.5), moderate/severe histological inflammation within 5 years of LGD diagnosis (HR = 3.0; 95% CI 1.3-6.7), and multifocality (HR = 2.8; 95% CI 1.3-6.1). In the validation cohort, this 4-variable model accurately predicted future AN cases with overall calibration Observed/Expected = 1 (95% CI 0.63-1.5), and achieved perfect specificity for the lowest predicted risk group over 13 years of follow-up. Conclusion Multi-cohort validation confirms that patients with large, unresected, and multifocal LGD and recent moderate/severe inflammation are at the highest risk of developing AN. Personalised risk prediction provided via the Ulcerative Colitis-Cancer Risk Estimator web-tool (www.UC-CaRE.uk) can be used to support treatment decision-making.

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Endoscopic submucosal dissection for nonpolypoid colorectal dysplasia in patients with inflammatory bowel disease: in medias res

Cited by 27 publications

References 28 publications

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study

Multi-centre derivation and validation of a colitis-associated colorectal cancer risk prediction web-tool

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