The role of colorectal endoscopic submucosal dissection in patients with ulcerative colitis

Kinoshita, Satoshi; Uraoka, Toshio; Nishizawa, Toshihiro; Naganuma, Makoto; Iwao, Yasushi; Ochiai, Yasutoshi; Fujimoto, Ai; Goto, Osamu; Shimoda, Masayuki; Ogata, Haruhiko; Kanai, Takanori; Yahagi, Naohisa

doi:10.1016/j.gie.2017.10.035

Cited by 74 publications

(127 citation statements)

References 22 publications

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“…The discrepancies are likely to reflect the heterogeneity of these tumors, as the tumors are thought to follow the adenoma-carcinoma sequence in the duodenum, colon, and rectum [18]. Our group previously assessed the sensitivity of preoperative diagnoses based on biopsy in ulcerative colitis [16]. Biopsy predicted a final histologic diagnosis of carcinoma with a sensitivity of 72.2% (13/18) and accuracy of 78.2% (18/23).…”

Section: Preoperative Diagnoses In Ulcerative Colitismentioning

confidence: 99%

“…Early colorectal adenocarcinomas are differentiated from adenomas with a reported sensitivity and accuracy of 83-85 and 73%, respectively, in magnifying endoscopy with crystal violet dye or magnifying narrow-band imaging (NBI) [19]. Our group previously assessed the sensitivity and accuracy of endoscopic preoperative diagnoses in ulcerative colitis [16]. The endoscopic findings (crystal violet staining and magnifying NBI) predicted a final histologic diagnosis of carcinoma or high-grade dysplasia with a sensitivity of 72.2% (13/18) and accuracy of 76% (19/25).…”

Section: Preoperative Diagnoses In Ulcerative Colitismentioning

confidence: 99%

“…Given the great merit of ESD and safety improvements, the technique has been adopted as a standard treatment in Japan and other East Asian countries. Several reports have also suggested that ESD is feasible for large neoplasms in ulcerative colitis [14][15][16]. In this article, we review ESD as a treatment for neoplastic lesions in ulcerative colitis.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

et al. 2018

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Patients with ulcerative colitis have an increased risk of developing colorectal cancer. This risk has been estimated to reach about 7% at 20 years of disease, 7–14% at 25 years, and as high as 30% after 35 years. The guidelines for the management of inflammatory bowel disease recommend endoscopic resection of circumscribed dysplasia and ongoing colonoscopic surveillance as a reasonable strategy in patients with ulcerative colitis. Submucosal fibrosis due to background inflammation could hamper adequate lifting and endoscopic treatment. Endoscopic mucosal resection (EMR) is difficult for dysplasia within colitic mucosa due to the non-lifting sign. Although endoscopic submucosal dissection (ESD) generally has higher risks of perforation and bleeding compared to EMR, the technique can achieve complete en bloc resection regardless of the lesion size or severity of submucosal fibrosis. Several studies have shown that ESD for circumscribed dysplasia in ulcerative colitis is feasible. While ESD can avert unnecessary surgery, submucosal fibrosis makes the intervention technically demanding in cases of ulcerative colitis. ESD should be performed by expert endoscopists using the most suitable equipment and devices available.

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Section: Preoperative Diagnoses In Ulcerative Colitismentioning

confidence: 99%

Section: Preoperative Diagnoses In Ulcerative Colitismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

et al. 2018

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“…However, the feasibility of ESD for UC‐associated dysplasia has not yet been extensively investigated. Three recent studies about ESD for dysplasia have reported en bloc and R0 resection rates ranging from 80% to 100% and from 70% to 76%, respectively . However, these studies did not describe the processes used by the endoscopists to assess the endoscopic resectability of the dysplasias.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ulcerative colitis‐associated dysplasia patients referred for potential endoscopic submucosal dissection

Yang

Kim

Song

et al. 2019

J of Gastro and Hepatol

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Background and Aim The feasibility of endoscopic submucosal dissection (ESD) as a treatment option for dysplasia in ulcerative colitis (UC) has been reported, but the associated therapeutic decision‐making and clinical outcomes have not been extensively investigated. Methods We retrospectively reviewed 25 UC patients who were referred for potential ESD of non‐polypoid or sessile dysplasia. We analyzed the treatment decisions and the ESD and colectomy outcomes for this patient group. Results All lesions were located at the colitic segments. The median UC duration was 13.4 years. A colectomy was recommended for 10 patients because of ulceration with indistinct borders (one patient), non‐ulceration with indistinct borders (two patients), and non‐lifting signs (seven patients). The remaining 15 patients underwent ESD. The en bloc and R0 resection rates were 93.3% and 80%, respectively. The median hospitalization periods were 1 (range, 1–2) day after ESD and 7 (range, 5–30) days after colectomy. No procedure‐related complications occurred after ESD, but early and late postoperative complications occurred in two (22.2%) and six (66.7%) of the colectomized patients, respectively. Fourteen ESD cases were followed endoscopically for a median period of 24.7 (range, 5.2–64.8) months. Local recurrence occurred in 2 (14.3%) patients, and metachronous recurrence was identified in two separate patients (14.3%). Conclusions Endoscopic submucosal dissection is a feasible endoscopic treatment option for UC‐associated dysplasia showing noninvasive pit or vascular patterns, no surface ulceration, distinct borders, and appropriate lifting after submucosal injection. Meticulous endoscopic surveillance is essential to monitor for local or metachronous recurrence of dysplasia after ESD.

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“…DCE and VCE may be usefully combined especially to characterise lesions and define margins accurately for EMR and ESD, but this requires further study. In the future we should not be hesitant to implement new colon sparing endoscopic management of colonic dysplastic lesions 59. We illustrated ESD technique in figure 4.…”

Section: Applications Of New Technologies That Are Available In Ibdmentioning

confidence: 99%

Advanced endoscopic techniques in the assessment of inflammatory bowel disease: new technology, new era

Iacucci

Furfaro

Matsumoto

et al. 2018

Gut

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Endoscopic assessment of inflammation and mucosal healing is crucial for appropriate management in IBD. Current definition of endoscopic mucosal healing has been derived using previous generation of standard white light endoscopes. New endoscopy technologies widely available provide much more detailed images of mucosal and vascular patterns. Novel endoscopic techniques with high definition image, optical and digital enhancement have enhanced the quality and fine details of vascular and mucosal pattern so that endoscopic images have started to reflect histological changes for lesions and inflammation/healing. These technologies can now define subtle inflammatory changes and increase detection and characterisation of colonic lesions in patients with IBD. The best endoscopic technique to detect dysplasia in IBD is still debated. Dye chromoendoscopy with targeted biopsies is considered by Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC consensus the standard of care and recommended for adoption by gastroenterologists in practice. In future, it is possible that well-trained colonoscopists using high definition equipment with image enhancements may be able to obtain equivalent yield without pan-colonic dye spraying and characterise lesions. Finally, SCENIC introduced endoscopic resectability of some dysplastic colonic lesions—new techniques may now better characterise endoscopic resectability and limit the number of colectomies. In this review, we will provide a state-of-the-art opinion on the direction of technological advances in the assessment of IBD and how new concepts will refine clinical practice.

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The role of colorectal endoscopic submucosal dissection in patients with ulcerative colitis

Cited by 74 publications

References 22 publications

Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

Outcomes of ulcerative colitis‐associated dysplasia patients referred for potential endoscopic submucosal dissection

Advanced endoscopic techniques in the assessment of inflammatory bowel disease: new technology, new era

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