A CASE SERIES: FEASIBILITY AND SAFETY OF ENDOSCOPIC RESECTION FOR COLORECTAL DYSPLASIA IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Patients with inflammatory bowel disease (IBD) are at a significantly increased risk of developing colorectal cancer (CRC). Dysplastic lesions secondary to IBD are also often more complex with larger size, nonpolypoid morphology, and in challenging locations not amenable to conventional resection techniques. The development of advanced resection techniques, in select cases, poses an alternative to traditional surgical management. This case series aims to highlight the success our academic center has had utilizing advanced techniques. METHODS We conducted a retrospective case series of patients referred for endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), endoscopic full thickness resection (EFTR), and other hybrid techniques. The primary outcome was the rate of curative resection, meaning when no further intervention (surgical or endoscopic) was indicated and there was no evidence of residual/recurrent disease at the end of a six month follow-up period. Secondarily, we describe rates of adverse events, en bloc and complete (R0) resection, and metachronous lesions. RESULTS A total of 24 dysplastic lesions (mean size 25.7mm [range 8-50mm], all Paris classification 0-II morphology) in 16 patients were included. 2 patients were noted to have lesions not amenable to endoscopic resection. Of the resected lesions, 8 were by ESD, 4 by hybrid ESD, 11 by EMR, and 1 by EFTR. With 7/24 (29.2%) lesions pending follow-up, curative resection was achieved in 14/17 lesions (82.4%). 2/17 (11.8%) lesions required follow-up endoscopic management and 1/17 (5.9%) lesions required follow-up colectomy due to patient preference, despite a technically successful resection of a pT1 adenocarcinoma (R0 and no adverse advents). Post-procedural bleeding occurred in two lesion resections (8.3%), with one being on apixaban, and both managed endoscopically. En bloc and R0 resection was achieved in 8/8 lesions (100%) done by ESD; and all other resection techniques achieved piecemeal and R1/Rx resection. Metachronous lesions were identified 13/17 (76.5%) follow-up colonoscopies. DISCUSSION Advanced endoscopic resection techniques are a safe and effective alternative to surgical management of complex colorectal dysplasia secondary to IBD. When lesion characteristics dictate, ESD, in particular, is effective at achieving en bloc and R0 resection. With a high-rate of metachronous lesions, ongoing endoscopic surveillance is necessary. Next steps are to continue this study to a greater sample size giving more power to analyze certain lesion characteristics as predictors of endoscopic success.