Longitudinal outcomes of the endoscopic resection of nonpolypoid dysplastic lesions in patients with inflammatory bowel disease

• Published in: Gastrointestinal endoscopy Vol. 97; no. 5; pp. 934 - 940
• Main Authors: Kaltenbach, Tonya, Holmes, Ian, Nguyen-Vu, Tiffany, Malvar, Carmel, Balitzer, Dana, Fong, Dean, Fu, Aurelia, Shergill, Amandeep, McQuaid, Kenneth, Soetikno, Roy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023
• Subjects: Carcinoma in Situ - surgery; Colectomy; Colonoscopy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Humans; Hyperplasia; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - pathology; Inflammatory Bowel Diseases - surgery; Retrospective Studies; SEC; IBD; NP-CRD; ESD
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2023.01.019

Patients with inflammatory bowel disease (IBD) are at risk of developing dysplasia. According to the Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations, “After complete removal of endoscopically resectable nonpolypoid dysplastic lesions, surveillance colonoscopy is suggested rather than colectomy.” We sought to add data to the literature and hypothesized that the endoscopic resection of nonpolypoid colorectal dysplasia (NP-CRD) is safe and effective. We conducted a retrospective study of a large cohort of patients with IBD at 2 medical centers who underwent colonoscopy between 2007 and 2018. Patients with at least 1 nonpolypoid lesion ≥10 mm were identified. We measured the feasibility of endoscopic resection, incidence of local recurrence, incidence of cancer, need for surgery, and frequency of adverse events. We studied 326 patients who underwent a mean ± standard deviation of 3.6 ± 3.0 (range, 1-16) colonoscopies during a total follow-up of 1208 patient-years. In 36 patients, 161 lesions ≥10 mm were identified, 63 of which were nonpolypoid (mean size, 17.8 ± 8.9 mm; range, 10-45 mm) (prevalence, 7.7%). The majority of nonpolypoid lesions (96.8% [61 of 63]) were managed endoscopically. Four lesions (mean index lesion size, 32.5 ±11.0 mm) had small local recurrences that were successfully retreated with endoscopy. There were no severe adverse events related to IBD or colorectal cancer observed in the follow-up period. In this IBD cohort, surveillance colonoscopy rather than colectomy was found to be safe and effective in patients with NP-CRD after undergoing endoscopic resection. After complete removal of endoscopically resectable NP-CRD, surveillance colonoscopy should be considered a safe and effective first-line strategy rather than colectomy.