Real-World Experience of Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Neoplasia

Abstract

Introduction: Patients with ulcerative colitis (UC) have an increased risk of colorectal cancer. Some studies have recently investigated endoscopic resection of UC-associated neoplasia (UCAN), but the indications for endoscopic resection of UCAN remain controversial. This study sought to clarify the problems encountered in endoscopic submucosal dissection (ESD) for UCAN. Methods: Seventeen lesions in 12 patients with UCAN (UCAN group) and 913 epithelial lesions in 824 control patients without UC (non-UC group) were evaluated. Both groups underwent ESD between January 2010 and December 2017 at Toranomon Hospital, Tokyo, Japan. Treatment outcomes of the 2 groups were compared retrospectively. Results: Univariate analysis showed that the mean tumor size was significantly smaller in the UCAN group than in the non-UC group (25.1 ± 26.7 mm vs. 31.9 ± 19.0; p = 0.0023); however, the R0 resection rate was significantly lower in the UCAN group (70.6 vs. 92.9%; p = 0.001). Multivariate analysis showed a significantly lower negative horizontal margin rate in the UCAN group (odds ratio 11.3, 95% confidence interval 3.588–34.525; p = 0.000). Discussion/Conclusion: ESD for UCAN is associated with a low-negative horizontal margin rate. When performing ESD for UCAN, it is important to evaluate the accuracy of the UCAN demarcation line, especially for flat lesions, using white-light imaging and chromoendoscopy as well as other modalities, including biopsy of surrounding tissues.

Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis

“…However, factors that affected the resection rates were different among the studies. In our meta-analysis, the reasons for R0 resection and noncurative resection were severe submucosal fibrosis [ 14 , 16 , 18 , 19 ], deep submucosal invasion of cancer [ 14 – 16 ], and positive horizontal margin [ 15 , 21 ]. The different reasons for non R0 resection among these studies might be the source of heterogeneity.…”

“…Of these articles, 13 studies were selected for further full-text evaluation after a review of the titles and abstracts. Of the 13 records, 8 studies fulfilled the criteria for inclusion in a quantitative synthesis (meta-analysis) [14][15][16][17][18][19][20][21].…”

Use of advanced endoscopic technology for optical characterization of neoplasia in patients with ulcerative colitis: Systematic review

“…Second, the differentiation of sporadic neoplasia from UCAN is also challenging: even the histological definition has not been confirmed. However, the treatment strategy is an important issue: aggressive endoscopic treatment is gaining acceptance as a diagnostic option for sporadic neoplasms but is still controversial for colitis‐associated neoplasia 42,54–58 …”

“…No research to date has focused on optical diagnosis of the horizontal extent of lesions. Matsui et al 57 . evaluated the outcomes of endoscopic submucosal dissection and found that 29% (5/17) of cases had a positive horizonal margin, mainly due to an undetected demarcation line of dysplasia around the superficial elevated lesion.…”

Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and Post-Operative Pouch Complications in UC: A Systematic Review

“…The advantage of ESD is total excision biopsy to evaluate the lesion. Compared to non-UC patients, ESD in UC is associated with lower rate of Ro resection (71% vs. 93%) with lower probability of negative horizontal margin [50]. Hence the demarcation line should be ascertained.…”