Outcomes of endoscopic submucosal dissection for high-risk colorectal colitis-associated neoplasia in inflammatory bowel disease

Background Patients with inflammatory bowel disease(IBD) have an increased risk of colorectal cancer. High-risk colorectal colitis-associated neoplasia (HR-CAN) can be difficult to treat using traditional endoscopic resection methods. This study evaluated the outcomes of endoscopic sub-mucosal dissection (ESD) in patients with IBD and HR-CANs. Methods This retrospective multicenter study consecu-tively included patients with IBD who were referred to ex-pert Italian endoscopy centers for ESD or hybrid ESD(hESD) of HR-CANs. The main outcomes were rates of enbloc, R0, and curative resections, adverse events, local recurrence, metachronous lesions, and post-resection surgery. Kaplan-Meier method was used to analyze survival rates. Risk factors associated with the main outcomes were investigated by univariable analysis.Results91 patients with colonic IBD (disease duration 15.3[SD 8.7] years, 82.4% with ulcerative colitis) with 96 HR-CANs (mean size 34.8 [SD 16.2] mm, 53.1% high grade dys-plasia/adenocarcinoma) were included. ESD and hESD were performed in 82.3% and 17.7%, respectively. En bloc, R0,and curative resections were achieved in 95.8% (95%CI89.6-98.8), 85.4% (95%CI 76.7-91.7), and 83.3% (95%CI74.3-90.1). Adverse events occurred in 12.5% (95%CI 6.6-20.8), which were all conservatively managed. After a mean follow-up of 23.4 (SD 16.1) months, local recurrence and metachronous lesions each occurred in 3.1%. Post-resection surgery was required in 11.5%.ConclusionsESD of HR-CANs showed favorable outcomes on the medium- and long-term course in patients with IBD