Advanced endoscopic resection for colorectal dysplasia in inflammatory bowel disease: a meta-analysis

Abstract

Background and study aims Little is known about outcomes of advanced endoscopic resection (ER) for patients with inflammatory bowel disease (IBD) with dysplasia. The aim of our meta-analysis was to estimate the safety and efficacy of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for dysplastic lesions in patients with IBD.

Methods We performed a systematic review through Jan 2021 to identify studies of IBD with dysplasia that was treated by EMR or ESD. We estimated the pooled rates of complete ER, adverse events, post-ER surgery, and recurrence. Proportions were pooled by random effect models.

Results Eleven studies including 506 patients and 610 lesions were included. Mean lesion size was 23 mm. The pooled rate of complete ER was 97.9 % (95 % confidence interval [CI]: 95.3 % to 99.7 %). The pooled rate of endoscopic perforation was 0.8 % (95 % CI:0.1 % to 2.2 %) while bleeding occurred in 1.6 % of patients (95 %CI:0.4 % to 3.3 %). Overall, 6.6 % of patients (95 %CI:3.6 % to 10.2 %) underwent surgery after an ER. Among 471 patients who underwent surveillance, local recurrence occurred in 4.9 % patients (95 % CI:1.0 % to 10.7 %) and metachronous lesions occurred in 7.4 % patients (95 %CI:1.5 % to 16 %) over a median follow-up of 33 months. Metachronous colorectal cancer (CRC) was detected in 0.2 % of patients (95 %CI:0 % to 2.2 %) during the surveillance period.

Conclusions Advanced ER is safe and effective in the management of large dysplastic lesions in IBD and warrants consideration as first-line therapy. Although the risk of developing CRC after ER is low, meticulous endoscopic surveillance is crucial to monitor for local or metachronous recurrence of dysplasia.

Publikationsverlauf

Eingereicht: 10. Oktober 2021

Angenommen nach Revision: 26. November 2021

Artikel online veröffentlicht:
13. Mai 2022

• References

• 1 Laine L, Kaltenbach T, Barkun A. et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148: 639-651
• 2 Mohan BP, Khan SR, Chandan S. et al. Endoscopicresection of colon dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis. Gastrointest Endos 2020;
• 3 Kisiel JB, Loftus Jr EV, Harmsen WS. et al. Outcome of sporadic adenomas and adenoma-like dysplasia in patients with ulcerative colitis undergoing polypectomy. Inflamm Bowel Dis 2012; 18: 226-235
• 4 Choi CHRWA, Landy J. et al. Endoscopic resection of raised dysplastic lesions in ulcerative colitis: long-term outcome [abstract]. Gastrointest Endosc 2014; 1: AB466
• 5 Wells GA, Shea B, OʼConnell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. February 16.
• 6 Iacopini F, Saito Y, Yamada M. et al. Curative endoscopic submucosal dissection of large nonpolypoid superficial neoplasms in ulcerative colitis (with videos). Gastrointest Endosc 2015; 82: 734-738
• 7 Suzuki N, Toyonaga T, East JE. Endoscopic submucosal dissection of colitis-related dysplasia. Endoscopy 2017; 49: 1237-1242
• 8 Kinoshita S, Uraoka T, Nishizawa T. et al. The role of colorectal endoscopic submucosal dissection in patients with ulcerative colitis. Gastrointest Endosc 2018; 87: 1079-1084
• 9 Matsumoto K, Oka S, Tanaka S. et al. Long-term outcomes after endoscopic submucosal dissection for ulcerative colitis-associated dysplasia. Digestion; 2019: 1-11
• 10 Yang DH, Kim J, Song EM. et al. Outcomes of ulcerative colitis-associated dysplasia patients referred for potential endoscopic submucosal dissection. J Gastroenterol Hepatol 2019;
• 11 Smith LA, Baraza W, Tiffin N. et al. Endoscopic resection of adenoma-like mass in chronic ulcerative colitis using a combined endoscopic mucosal resection and cap assisted submucosal dissection technique. Inflamm Bowel Dis 2008; 14: 1380-1386
• 12 Hurlstone DP, Sanders DS, Atkinson R. et al. Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: can we change the endoscopic management paradigm?. Gut 2007; 56: 838-846
• 13 Gulati S, Emmanuel A, Burt M. et al. Outcomes of endoscopic resections of large laterally spreading colorectal lesions in inflammatory bowel disease: a single United Kingdom Center experience. Inflamm Bowel Dis 2018; 24: 1196-1203
• 14 Al-Kandari A, Thayalasekaran S, Bhandari M. et al. Endoscopic resections in inflammatory bowel disease: a multicentre European outcomes study. J Crohns Colitis 2019;
• 15 Yadav S, Loftus Jr EV, Harmsen WS. et al. Outcome of endoscopic resection of colonic polyps larger than 10 mm in patients with inflammatory bowel disease. Endosc Int Open 2019; 7: E994-E1001
• 16 Nishio M, Hirasawa K, Ozeki Y. et al. An endoscopic treatment strategy for superficial tumors in patients with ulcerative colitis. J Gastroenterol Hepatol 2020;
• 17 Alkandari A, Thayalasekaran S, Bhandari M. et al. Endoscopic resections in inflammatory bowel disease: a multicentre european outcomes study. J Crohns Colitis 2019; 13: 1394-1400
• 18 Hassan C, Repici A, Sharma P. et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65: 806-820
• 19 Kothari ST, Huang RJ, Shaukat A. et al. ASGE review of adverse events in colonoscopy. Gastrointest Endosc 2019; 90: 863-876e33
• 20 Thomas T, Abrams KA, Robinson RJ. et al. Meta-analysis: cancer risk of low-grade dysplasia in chronic ulcerative colitis. Aliment Pharmacol Ther 2007; 25: 657-668
• 21 Wanders LK, Dekker E, Pullens B. et al. Cancer risk after resection of polypoid dysplasia in patients with longstanding ulcerative colitis: a meta-analysis. Clin Gastroenterol Hepatol 2014; 12: 756-764