Endoscopy 2020; 52(S 01): S16
DOI: 10.1055/s-0040-1704056
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30 – 10:30 Endoscopy in flames Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

LARGE SUPERFICIAL NEOPLASMS IN INFLAMMATORY BOWEL DISEASES: ENDOSCOPIC SUBMUCOSAL DISSECTION STRATEGY

F Iacopini
1   Gastroenterology and Endoscopy, Ospedale dei Castelli, Ariccia, , Rome, Italy
,
R Pica
2   Ospedale Pertini, Gastroenterology and Endoscopy Unit, Rome, Italy
,
E Calabrese
3   Policlinico Università Tor Vergata, Gastroenterology, Rome, Italy
,
F Montagnese
4   Gastroenterology and Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy
,
T Gotoda
5   Nihon University School of Medicine, Chiyoda-ku, Japan
,
G Costamagna
6   Pol. Gemelli, Univ Cattolica, Rome, Italy
,
Y Saito
7   Endoscopy Division, National Cancer Center Hospital, Tokyo, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

 

Aims Patients with long-standing active inflammatory bowel diseases (IBD) have an increased risk of colorectal dysplasia. Guidelines recommend endoscopic resection for superficial neoplasms when en bloc is feasible but endoscopic submucosal dissection (ESD) has been reported in small series with no long-term outcomes. Aim was to evaluate ESD clinical outcomes for large IBD superficial neoplasms.

Methods Prospective case series of consecutive large (≥20 mm) IBD superficial neoplasms within the colitic mucosa referred for ESD. Short-term (en bloc and R0 resection rates) and long-term outcomes (residual and metachronous cancer rates within a minimum 24-month follow-up) were evaluated. Neoplasms were characterized by white light and chromo-endoscopy with narrow band imaging and acetic acid.

Results Thirteen patients with 15 superficial neoplasms underwent ESD. Neoplasms features: median size 28 mm (range 20-50 mm), nonpolypoid in 14 (93%) (LST-NG in 4), scar in 6 (40%), in the rectum and left colon in 9 (60%). Margins were delineated by acetic acid in 7 (47%). En bloc and R0 resections were achieved in 13 (87%) (2 cases with a TEM scar underwent piecemeal EMR) and 12 (80%) cases, respectively. Resection was always curative; T1a cancer in the perineal rectum above the dentate line was diagnosed in one. Submucosal fibrosis was observed in 9 (60%). No early and late adverse events occurred. Median follow-up was 44 months (range 24-54). Minute residual neoplasms were detected in the 2 (13%) EPMR cases and retreated by EMR. Metachronous superficial neoplasms were identified in 5 (33%) cases: 4 underwent endoscopic resection, 1 proctocolectomy due to multiple adjacent neoplasms with indistinct margins.

Conclusions ESD for IBD neoplasms is feasible but the difficulty gradient is high due to a high prevalence of LST-NG, scars, and SM fibrosis. ESD may avoid surgery but a strict surveillance is essential for a high incidence of metachronous lesions.