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Endoscopic management of patients with high-risk colorectal colitis-associated neoplasia: a Delphi study

Open AccessPublished:December 09, 2022DOI:https://doi.org/10.1016/j.gie.2022.12.005
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      Abstract

      Background and Aim

      Current guidelines recommend endoscopic resection of visible and endoscopically resectable colorectal colitis-associated neoplasia (CAN) in patients with inflammatory bowel disease (IBD). However, patients with high risk CAN are often not amenable to conventional resections techniques and a consensus approach for the endoscopic management of these lesions is presently lacking. This Delphi study aims to reach consensus amongst experts on the endoscopic management of these lesions.

      Methods

      A three-round modified Delphi process was conducted to reach consensus amongst worldwide IBD and/or endoscopy experts (n=18) from three continents. Consensus was considered if ≥ 75% agreed or disagreed. Quality of evidence was assessed by the criteria of the Cochrane Collaboration group.

      Results

      Consensus was reached on all statements (n=14). Experts agreed on a definition for CAN and high-risk CAN (HR-CAN). Consensus was reached on the examination of the colon with enhanced endoscopic imaging prior to resection, the endoscopic resectability of a HR-CAN lesion and endoscopic assessment and standard report of CAN lesions. In addition, experts agreed on type of resections of HR-CAN (< 20mm, >20 mm, with or without good lifting), endoscopic success (technical success and outcomes), histologic assessment and follow-up in HR-CAN.

      Conclusion

      This is the first step in developing international consensus-based recommendations for endoscopic management of (HR-)CAN. Although the quality of available evidence was considered low, consensus was reached on several aspects of the management of (HR-)CAN. The present work and proposed standardization might benefit future studies.

      Key words

      Abbreviations:

      Inflammatory bowel disease (IBD), colitis-associated neoplasia (CAN), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), ulcerative colitis (UC), colorectal cancer (CRC), high-grade dysplasia (HGD), Crohn’s disease (CD), ulcerative colitis endoscopic index of severity (UCEIS), the ulcerative colitis colonoscopic index of severity (UCCIS), Crohn's disease endoscopic index of severity (CDEIS), simple endoscopic score for Crohn's disease (SES-CD), high-risk colitis-associated neoplasia (HR-CAN), low-grade dysplasia (LGD), Large non-pedunculated colorectal polyps (LNPCPs), colorectal neoplasia (CRN), adenoma detection rate (ADR), deep submucosal invasion (DSI), lymph node metastasis (LNM), endoscopic full-thickness resection (eFTR), endoscopic intermuscular dissection (EID), piecemeal endoscopic mucosal resection (pEMR), underwater endoscopic mucosal resection (U-EMR), European Society of Gastrointestinal Endoscopy (ESGE), American Society of Gastrointestinal Endoscopy (ASGE), advanced colorectal neoplasia (aCRN)