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

• Published in: Journal of gastroenterology and hepatology 2019-09, Vol.34 (9), p.1581-1589
• Main Authors: Yang, Dong‐Hoon, Kim, Jihun, Song, Eun Mi, Chang, Kiju, Lee, Sun‐Ho, Hwang, Sung Wook, Park, Sang Hyoung, Ye, Byong Duk, Byeon, Jeong‐Sik, Myung, Seung‐Jae, Yang, Suk‐Kyun
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Clinical Decision-Making; colectomy; Colectomy - adverse effects; Colitis, Ulcerative - pathology; Colitis, Ulcerative - surgery; Colon - pathology; Colon - surgery; Colonoscopy - adverse effects; Databases, Factual; dysplasia; Endoscopic Mucosal Resection - adverse effects; endoscopic submucosal dissection; Feasibility Studies; Female; Humans; Length of Stay; Male; Middle Aged; Patient Selection; Postoperative Complications - etiology; Recurrence; Referral and Consultation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; ulcerative colitis; Young Adult
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.14623

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.