The Feasibility, Safety, and Long-term Outcomes of Endoscopic Submucosal Dissection for Colorectal Neoplasia in Patients With Inflammatory Bowel Disease

Abstract

Background: Evidence regarding the utility of endoscopic submucosal dissection (ESD) for neoplasia in patients with inflammatory bowel disease (IBD) is limited. This meta-analysis aims to understand the feasibility, safety, and long-term outcomes of ESD in IBD patients. Methods: Electronic databases were searched for observational and case-controlled studies. Primary endpoints were en bloc resection and margin-negative resection of neoplastic lesions. Secondary endpoints included procedure-related bleeding and perforation, local recurrence, and metachronous neoplasia. Results: We analyzed 25 studies with a total of 585 neoplastic lesions in 552 patients. The rates of en bloc resection and margin-negative resection were 0.88 [95% confidence interval (CI) 0.82-0.92] and 0.78 (95% CI 0.72-0.83), respectively. Meta-regression analysis showed longer disease duration was significantly associated with the higher rate of en bloc resection. The rates of procedure-related bleeding and perforation were 0.080 (95% CI 0.057-0.11) and 0.055 (95% CI 0.038-0.081), respectively. The rates of local recurrence and metachronous neoplasia were 0.008 events/person-year (95% CI 0.002-0.013) and 0.031 event/person-year (95% CI 0.016-0.046), respectively. Meta-analysis of case-controlled studies found no significant differences in the endpoints between IBD patients treated by ESD and those treated by endoscopic mucosal resection, or non-IBD patients treated by ESD. Conclusions: ESD is a feasible and safe procedure to remove neoplastic lesions in IBD patients. Given there is a considerable risk of metachronous neoplasia development, postoperative surveillance colonoscopy with an appropriate consultation with surgeons is essential to monitor not only local recurrence but also neoplastic changes in the remaining colon.

A radiomics nomogram based on MSCT and clinical factors can stratify fibrosis in inflammatory bowel disease

“…Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic and relapsing inflammatory disorder of the gastrointestinal tract 1,2 . The global incidence of inflammatory bowel disease (IBD) increased by 47.45%, from an estimated 3.32 million cases to 4.90 million cases between 1990 and 2019, which poses significant impacts in patients' quality of life and challenges in terms of diagnosis, treatment, and management [3][4][5][6][7] . One of the key complications of IBD is the development of fibrosis, a pathological process characterized by excessive accumulation of extracellular matrix components in the affected intestinal wall 8 .…”