FEASIBILITY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SPORADIC NEOPLASMS IN PATIENTS WITH ULCERATIVE COLITIS

Aims In patients with ulcerative colitis (UC), sporadic neoplasms (SN) can also occur in addition to UC-associated colorectal cancer/dysplasia (UCAC). Recently, endoscopic submucosal dissection (ESD) of SN for diagnostic purposes has been reported. However, here is no consensus regarding ESD. We retrospectively evaluated the feasibility of ESD for SN.

Methods The subjects were 25 patients with 28 lesions who met the following criteria: diagnosed with a UC associated lesion; were in the remission phase and had well-circumscribed, single lesions with no dysplasia in the periphery. The patients were preoperatively diagnosed as having SN, and had undergone ESD for reasons of difficulty in distinguishing UCAC/SN even on the basis of magnified endoscopic and biopsy findings, with the postoperative pathology results leading to the diagnosis of SN.

Results The mean age of the patients was 59.9 years, and the mean disease period was 16.9 years. The en bloc resection rate by ESD was 96.4%, R0 resection rate was 89.2%, the mean tumour diameter was 28.4 mm, and the mean procedure time was 58.3 min. The adverse eventswere perforation in 1 patient, and postoperative bleeding in 1 patient. The histopathological examinations after ESD revealed 13 cancer lesions and 15 adenoma lesions. All lesions suspected as SN were confirmed as SN. Although 2 of the 15 patients followed up after ESD (mean observation period, 36.4 months) showed metachronous lesions, both had SN.

Conclusions ESD for lesions with UC was feasible. ESD is recommended as an optimal treatment for en bloc excision and accurate pathological diagnosis, which is essential in determining the appropriate treatment strategy.