Outcomes of Endoscopic Resections of Large Laterally Spreading Colorectal Lesions in Inflammatory Bowel Disease: a Single United Kingdom Center Experience

Abstract

This cohort series demonstrates that endoscopic resection of large non-polypoid lesions associated with colitis is feasible and safe using an array of resection methods supporting the role of advanced endoscopic therapeutics for the management of colitis associated dysplasia in a western tertiary endoscopic center.

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

“…The strength of this systematic review of videoendoscopic era studies is that it has attempted to clarify the risk of dysplasia progression to advanced neoplasia and specifically the risk of metachronous advanced neoplasia after endoscopic resection of colitis‐associated dysplasia in the videoendoscopic era. In addition, this review has identified a further 20 studies not included in Fumery et al's meta‐analysis 31,33‐38,40‐46,51‐54,56,57 . The wide variation in outcomes demonstrated by our systematic review may be explained by a number of factors.…”

“…These are technically difficult procedures performed by a small number of specialist endoscopists for high‐risk lesions. Description of histological R0 resection success and intensive post‐polypectomy surveillance intervals are strictly adhered to in these more recent studies, which have demonstrated that achieving R0 resection and adhering to close follow‐up by expert endoscopists are associated with a lower risk of metachronous advanced neoplasia than previously thought 41‐46,54 . Therefore, although of low quality, the evidence supports the practice of continued close surveillance of patients following successful R0 resection of dysplastic lesions.…”

“…During the post‐resection follow‐up, one case of metachronous HGD (5.0%) developed over a median of 1.75 years. In Gulati et al's 54 UK case series, nine LGD lesions with a mean diameter of 48 mm were resected using either endoscopic mucosal resection, endoscopic submucosal dissection or hybrid techniques. R0 resection was only achieved in 40%.…”

“…Most of the follow‐up studies of endoscopically resected dysplasia where these adjuncts were used with surveillance are associated with the lowest advanced neoplasia progression rates 13,34,41‐43,45,53 . The only studies to show significant advanced neoplasia progression despite use of these adjuncts were in one study where high‐definition imaging but no chromoendoscopy surveillance was used after resection of LGD and HGD polyps 37 and in two studies where high‐definition chromoendoscopy surveillance was performed after resection of high‐risk large nonpolypoid LGD lesions with significant submucosal fibrosis and where R0 resection rates were less than 70% 46,54 …”

“…It should be noted that very small numbers of HGD have been included in the post‐polypectomy surveillance studies, making the evidence for choosing continued surveillance over colectomy after visible HGD resection of even lower quality than that for visible LGD. In addition, case series of large high‐risk nonpolypoid dysplastic lesions where significant submucosal fibrosis resulted in low R0 resection rates and progression rates to cancer of 22%‐40% with LGD 46,54 and 50% with HGD 46 highlights the need for caution when deciding to delay a colectomy in these high‐risk patients.…”