Outcomes of Endoscopic Submucosal Dissection for High-Risk Colorectal Colitis-Associated Neoplasia in Inflammatory Bowel Disease

Introduction: Inflammatory bowel disease (IBD) patients have an increased risk of developing colorectal cancer. High-risk colorectal colitis-associated neoplasia (HR-CAN) can be difficult to treat using traditional endoscopic resection methods. Aim of the study is to evaluate the outcomes of endoscopic submucosal dissection (ESD) on IBD patients with HR-CANs. Methods: In this retrospective multicenter study, we consecutively included IBD patients referred to expert Italian endoscopy centers who underwent ESD or hybrid-ESD (hESD) for HR-CANs. Main outcomes were the rate of en-bloc, R0, curative resections, adverse events (AEs), the rate of local recurrence, metachronous lesions, and post-resection surgery. Kaplan-Meier method was used to analyze survival curves. Risk factors associated to main outcomes were investigated by univariable analysis. Results: Ninety-one colonic IBD patients (83.4% ulcerative colitis, disease duration of 15.3 ± 8.7 years) with 96 HR-CANs (53.1% high-grade dysplasia/adenocarcinoma, size 34.8 mm ± 16.2 mm) were included. ESD and hESD were performed in 82.3% and 17.7% of cases. En-bloc, R0, and curative resections were achieved in 95.9% (95% CI 0.958; 0.896-0.988), 85.4% (95% CI 0.854; 0.767-0.917), and 83.3% (95% CI 0.833; 0.743-0.901) of cases. AEs occurred in 12.5% (95% CI 0.125; 0.066-0.208) of cases, which were all conservatively managed. After a mean follow-up of 23.4 ± 16.1 months, local recurrence and metachronous lesions occurred each in 3.1% (95% CI 0.031; 0.006-0.088) of cases. Post-resection surgery was required in 11.5% (95%CI 0.114; 0.058-0.195) of cases. Conclusions: ESD of HR-CANs shows favorable outcomes on the medium and long-term course in IBD patients.