Endoscopy 2017; 49(12): 1237-1242
DOI: 10.1055/s-0043-114410
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection of colitis-related dysplasia

Noriko Suzuki
1   Wolfson Unit for Endoscopy, St. Markʼs Hospital, London, UK
,
Takashi Toyonaga
2   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
,
James E. East
3   Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
› Author Affiliations
Further Information

Publication History

submitted 05 March 2017

accepted after revision 26 May 2017

Publication Date:
14 August 2017 (online)

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) offers en bloc resection of lesions, allowing precise pathological assessment. Although possible in ulcerative colitis (UC) patients, the chronic inflammation may increase the procedural risks and reduce the complete resection rate. The aim of this study was to assess the feasibility of ESD for UC and to consider the factors contributing to its technical difficulty.

Patients and methods Multicenter experiences of ESD for UC were retrospectively analyzed by reviewing endoscopic videos, pictures, reports, and clinical notes.

Results A total of 32 dysplastic lesions were included (23 in British patients, 9 in Japanese patients). The lesions were macroscopically flat or with subtle extension macroscopically in 30 patients (94 %), with a median size of 33 mm (range 12 – 73 mm), and were located in the distal colon, including one on a pouch anastomosis. Submucosal fibrosis and adipose deposition were observed in 31 (97 %) and 13 lesions (41 %), respectively. En bloc resection was possible in 29/32 lesions (91 %). One patient had delayed bleeding. Advanced pathology was observed in 11 lesions (35 %). Recurrence was observed in only one patient (after a median of 33 months [range 6 – 76 months]); however, three patients developed metachronous lesions.

Conclusions ESD is feasible for UC dysplasia without an increased rate of complications. Submucosal fibrosis and fat deposition were frequently observed and contributed to the technical complexity. Careful and intensive follow-up should be organized to detect metachronous lesions.

 
  • References

  • 1 Rutter M, Saunders B, Wilkinson K. et al. Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology 2006; 130: 1030-1038
  • 2 Eaden J, Abrams K, Mayberry J. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48: 526-535
  • 3 Lakatos L, Mester G, Erdelyi Z. et al. Risk factors for ulcerative colitis-associated colorectal cancer in a Hungarian cohort of patients with ulcerative colitis: results of a population-based study. Inflamm Bowel Dis 2006; 12: 205-211
  • 4 Winther K, Jess T, Langholz E. et al. Long-term risk of cancer in ulcerative colitis: a population-based cohort study from Copenhagen County. Clin Gastroenterol Hepatol 2004; 2: 1088-1095
  • 5 Jess T, Simonsen J, Jørgensen K. et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375-381
  • 6 Herrinton L, Liu L, Levin T. et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382-389
  • 7 Laine L, Kaltenbach T, Barkun A. et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc 2015; 81: 489-501
  • 8 Mowat C, Cole A, Windsor A. et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60: 571-607
  • 9 Cairns S, Scholefield J, Steele R. et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-689
  • 10 Wanders L, Dekker E, Pullens B. et al. Cancer risk after resection of polypoid dysplasia in patients with longstanding ulcerative colitis: a meta-analysis. Clin Gastroenterol Hepatol 2014; 12: 756-764
  • 11 Choi C, Rutter M, Askari A. et al. Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview. Am J Gastroenterol 2015; 110: 1022-1034
  • 12 East JE, Toyonaga T, Suzuki N. Endoscopic management of nonpolypoid colorectal lesions in colonic IBD. Gastrointest Endosc Clin N Am 2014; 24: 435-445
  • 13 Iacopini F, Saito Y, Yamada M. et al. Curative endoscopic submucosal dissection of large nonpolypoid superficial neoplasms in ulcerative colitis (with videos). Gastrointest Endosc 2015; 82: 734-738
  • 14 Matsumoto A, Tanaka S, Oba S. et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010; 45: 1329-1337
  • 15 Toyonaga T, Man-i M, East J. et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
  • 16 Yoshioka S, Mitsuyama K, Takedatsu H. et al. Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging. Int J Oncol 2016; 48: 551-558
  • 17 Soetikno R, Subramanian V, Kaltenbach T. et al. The detection of nonpolypoid (flat and depressed) colorectal neoplasms in patients with inflammatory bowel disease. Gastroenterology 2013; 144: 1349-1352
  • 18 Rutter M, Riddell R. Colorectal dysplasia in inflammatory bowel disease: a clinicopathologic perspective. Clin Gastroenterol Hepatol 2014; 12: 359-367
  • 19 Soetikno R, Kaltenbach T, McQuaid KR. et al. Paradigm shift in the surveillance and management of dysplasia in inflammatory bowel disease (West). Dig Endosc 2016; 28: 266-273
  • 20 Isomoto H, Nishiyama H, Yamaguchi N. et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2009; 41: 679-683
  • 21 Ono S, Fujishiro M, Goto O. et al. Submerging endoscopic submucosal dissection leads to successful en bloc resection of colonic laterally spreading tumor with submucosal fat. Gut Liver 2008; 2: 209-212
  • 22 Toyonaga T, Man-i M, Fujita T. et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy 2010; 42: 714-722
  • 23 Gore RM. Colonic contour changes in chronic ulcerative colitis: reappraisal of some old concepts. AJR Am J Roentgenol 1992; 158: 59-61