Feasibility and safety of endoscopic submucosal dissection In inflammatory bowel disease (ESDEUR-IBD): an European retrospective study

Abstract

Background Colectomy is the primary treatment for dysplastic lesions in inflammatory bowel disease (IBD). Since the development of advanced endoscopic techniques, the management of dysplasia is evolving. Endoscopic submucosal resection (ESD) could be used in selected cases at referral centres as an alternative to colectomy. However, the feasibility and safety in IBD remains limited. Main aim: To evaluate en-bloc resection rate and the need of colectomy due to ESD failure in IBD.

Secondary aims to assess the complications of ESD, the local recurrence of dysplastic lesions, the presence of synchronous and metachronous lesions and the risk of IBD relapse following the procedure.

Methods Multicentre, retrospective study of IBD patients who underwent ESD for suspected colonic dysplastic lesions at least one month before the inclusion date. Patients with total colectomy before ESD, invisible dysplasia at the time of ESD, or pregnancy were excluded. En-bloc resection rate and colectomy due to ESD failure at the short term were evaluated by logistic regression analysis. The risk of IBD relapse was evaluated by Cox regression analysis.

Results Sixty-nine ESD from 23 centres were included: 55 with ulcerative colitis, 12 with Crohn’s disease and 2 with IBD-unclassified. The mean age at ESD was 63 years (SD 13). The majority of the lesions (n = 35, 50%) were in rectum. Sixty lesions (87%) were in areas previously inflamed. En-bloc and R0 were achieved in 66 (95%) and 53 patients (76%), respectively. Colectomy due to ESD failure was required in 7 patients (10%) (Figure 1A). Complications occurred in 20 patients (28%): 7 required pharmacologic therapy, 6 needed endoscopic or radiologic intervention, and 2 underwent surgery (Table 1). No deaths were reported.

At least one surveillance colonoscopy after ESD was performed in 47 patients (67%). Local recurrence was observed in 3 patients while other dysplastic lesions were detected in 33 (47%) during the follow-up (median 1.9 years, IQR 0.4-2.8). All these lesions were removed endoscopically. Synchronous and metachronous lesions were identified in 6 (24%) and 10 patients (21%), respectively. IBD relapse occurred in 10 patients during the follow-up, with an incidence rate of 7% person-year (CI 95%:3-15) (Figure 1B).

Conclusion Colectomy was avoided in 90% of IBD patients undergoing ESD for dysplastic lesions. One-third of the patients experienced complications, most of them resolved with no sequelae. Given the risk of new dysplastic lesions, ongoing monitoring with surveillance colonoscopies is recommended.