Endoluminal approaches for colorectal neoplasia in inflammatory bowel disease: a viable alternative for colectomy?

Ali Alipouriani; Stefan D Holubar; Kamil Erozkan; Lukas Schabl; Joshua Sommovilla; Michael Valente; Scott R Steele; Emre Gorgun

doi:10.1016/j.gassur.2024.101876

Endoluminal approaches for colorectal neoplasia in inflammatory bowel disease: a viable alternative for colectomy?

J Gastrointest Surg. 2024 Nov 7:101876. doi: 10.1016/j.gassur.2024.101876. Online ahead of print.

Authors

Ali Alipouriani¹, Stefan D Holubar¹, Kamil Erozkan¹, Lukas Schabl¹, Joshua Sommovilla¹, Michael Valente¹, Scott R Steele¹, Emre Gorgun²

Affiliations

¹ Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, United States.
² Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, United States. Electronic address: gorgune@ccf.org.

PMID: 39521036
DOI: 10.1016/j.gassur.2024.101876

Abstract

Background: Endoscopic resection of visible dysplastic lesions in patients with inflammatory bowel disease (IBD) is an alternative to colectomy. The endoscopic techniques that can be used include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and ESD combined with EMR. These endoscopic approaches may allow organ preservation in patients with IBD. This study aimed to evaluate the outcomes of endoscopic resection, including EMR, ESD, and ESD combined with EMR, for the treatment of colorectal dysplasia in patients with IBD.

Methods: This was a retrospective review of patients with IBD who underwent endoscopic resection for colorectal dysplasia at our tertiary care center between 2014 and 2023. Patients were identified via a search of our endoscopy database. Medical records were reviewed to collect data on patient demographics, IBD history, details of endoscopic technique, procedural factors, final pathology results, and outcomes, including recurrence of dysplasia.

Results: A total of 50 patients with IBD who underwent endoscopic resection were included in the study, with 38 ESD cases, 11 ESD combined with EMR cases, and 1 EMR case. The median age was 62 years, (IQR, 54-68), and 34 patients (68%) were male. The median body mass index was 27.6 kg/m² (IQR, 24.8-31.7). The underlying diagnoses were ulcerative colitis in 33 patients (66%) and Crohn's disease in 17 patients (33%). The median disease duration was 27.5 years (IQR, 8-30). Polyp locations were distributed as follows: right colon, rectum, left colon, transverse colon, and cecum, with 9 polyps (18%) in each area. The median procedure time was 47.5 min (IQR, 31.2-73.7). En bloc resection was performed in 34 patients (68%), and piecemeal resection was performed in 16 patients (32%). On pathology, the median lesion size was 23.5 mm (IQR, 20.2-40.0). High-grade dysplasia was found in 7 patients (14%), whereas low-grade dysplasia was found in 15 patients (30%). During a median follow-up period of 3 years, 18% of patients experienced recurrence. No significant difference in recurrence rates was observed between the ESD and ESD combined with EMR groups.

Conclusion: Endoscopic resection, including EMR, ESD, and ESD combined with EMR, is an effective treatment of visible dysplastic lesions and is a safe alternative to colectomy in patients with IBD. In this cohort, favorable short-term outcomes were observed after endoscopic resection.

Keywords: Endoluminal approach; Endoscopic mucosal resection; Endoscopic submucosal dissection; Inflammatory bowel disease.