Two-centre study on endoscopic mucosal resection (EMR) in treatment of colitis associated neoplasia (CAN)

Aims Endoscopic resection has been recommended as preferable therapeutic approachfor colitis associated neoplasia (CAN) in IBD patients. However, endoscopic resection of these lesions can be challenging due to ongoing inflammation, mucosal scarring, and submucosal fibrosis. We report a long-term, two-centre experience on performance of endoscopic mucosal resection (EMRs) for treatment of CANs.

Methods Hospital electronic database at Mayo Clinic, Rochester, USA and UZ Leuven, Leuven, Belgium were searched in order to identify all the patients diagnosed with CANs in period 01.01.2009-30.09.2023. Data on the lesion characteristics, therapeutic approach, treatment outcomes and follow-up were collected and used for the descriptive analysis.

Results During the study period 126 CANs have been treated with EMR in 113 patients in two centres included.Mean diameter of the lesion treated was 19.34±10.18mm (8-60mm). Among the lesions treated 77 were removed en-bloc (61.1%) while 49 (38.9%) were removed piece meal. Three EMRs (0.02%) were associated with post-procedural bleeding, which was treated endoscopically. Another 2 EMRs (0.02%) were associated with intraprocedural perforations which were resolved by placement of the endoclips. Four lesions (0.03%) were identified as adenocarcinoma with deep submucosal invasion and the patients werereferred to surgery. All the other patients were subjected to follow-up, during which 23 cases of local recurrence (18.2%) at the site of resection were observed, of which 14 (60.7%) were treated with new EMR while 9 (39.3%) werereferred to surgery. Apart from recurrent lesions, 20 more patients were in need for colorectal surgery during the follow up period due to occurrence ofmetachronousCANsthat could not be treated endoscopically. All together 31 out of 113 patients (27.4%) included in the study underwent colorectal surgery for CAN treatment.

Conclusions EMR appears to be a safe and effective in treatment option for CAN both in terms of short and long-terms outcomes, without need for surgery in 73% of patients. However meticulous follow-up is mandatory to identify metachronic CANs.

Publication History

Article published online:
27 March 2025