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J Crohns Colitis. 2019 Apr 17. pii: jjz075. doi: 10.1093/ecco-jcc/jjz075. [Epub ahead of print]

Endoscopic Resections in Inflammatory Bowel Disease: A Multicentre European Outcomes Study.

Author information

1
Queen Alexandra Hospital, Portsmouth, United Kingdom.
2
Department of Oncological Gastroenterology The Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland.
3
Statsconsultancy Limited, Amersham, United Kingdom.
4
Department of Gastroenterology, Division of Digestive Endoscopy, Humanities Research Hospital, Brzeziny, Poland.
5
University of Lodz - Center of Bowel Treatment, Brzeziny, Poland.
6
Kings Institute of Therapeutic Endoscopy, Warsaw, Poland.
7
Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.
8
Department of Gastroenterology, Queen Alexandra Hospital, Southwick Hill Road, Portsmouth.
#
Contributed equally

Abstract

BACKGROUND:

Inflammatory bowel disease is associated with an increased risk of colorectal cancer, with estimates ranging from 2-18%, depending on the duration of colitis. The management of neoplasia in colitis remains controversial. Current guidelines recommend endoscopic resection if the lesion is clearly visible with distinct margins. Colectomy is recommended if complete endoscopic resection isn't guaranteed.

AIMS:

To assess the outcomes of all neoplastic endoscopic resections in inflammatory bowel disease.

METHODS:

Multi-centre retrospective cohort study of 119 lesions of visible dysplasia in 93 patients resected endoscopically in inflammatory bowel disease.

RESULTS:

6/65 (9.2%) lesions <20mm in size were treated by ESD compared to 59/65 (90.8%) lesions <20mm treated by EMR. 16/51 (31.4%) lesions >20mm in size treated by EMR vs 35/51 (68.6%) by ESD. Almost all patients (97%) without fibrosis were treated by EMR and patients with fibrosis were treated by ESD (87%), 0<0.001. 49/78 (63%) lesions treated by EMR were resected en-bloc. 27/41 (65.9%) of the ESD/KAR cases were resected en-bloc, compared to 15/41 (36.6%) resected piecemeal. 7 recurrences occurred in the cohort. 7 complications occurred in the cohort; 6 were managed endoscopically and 1 patient with a delayed perforation underwent surgery.

CONCLUSION:

Larger lesions with fibrosis are best treated by ESD, whereas smaller lesions without fibrosis are best managed by EMR. Both EMR and ESD are feasible in the management of endoscopic resections in colitis.

PMID:
30994915
DOI:
10.1093/ecco-jcc/jjz075

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