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Abstract:
Background and Aims
Patients with inflammatory bowel disease (IBD) are at risk to develop dysplasia. The
SCENIC Consensus Statement states “After complete removal of endoscopically resectable
nonpolypoid dysplastic lesions, surveillance colonoscopy is suggested rather than
colectomy.” We sought to add data to the literature and hypothesized that the endoscopic
resection of NP-CRD is safe and effective.
Methods
We conducted a retrospective study of a large cohort of IBD patients at two medical
centers who underwent colonoscopy between 2007-2018. We identified patients with at
least one nonpolypoid lesion ≥10mm. We measured the feasibility of endoscopic resection,
incidence of local recurrence, incidence of cancer, need for surgery, and frequency
of complications.
Results
We studied 326 patients who underwent a mean of 3.6 ± 3.0 (range 1-16) colonoscopies
during a total follow-up of 1,208 patient-years. In 36 patients, we identified 161
lesions ≥ 10mm, 63 of which were nonpolypoid (mean size 17.8mm±8.9mm,range 10-45mm)
(prevalence 7.7%). The majority of nonpolypoid lesions (96.8%, 61/63) were managed
endoscopically. 4 lesions (mean index lesion size 32.5 ±11.0mm) had small local recurrence
that were successfully retreated with endoscopy. There were no severe complications
related to IBD or colorectal cancer observed in the follow up period.
Conclusion
In our IBD cohort patients with NP-CRD, after undergoing endoscopic resection, surveillance
colonoscopy rather than colectomy was safe and effective. After complete removal of
endoscopically resectable NP-CRD, surveillance colonoscopy should be considered a
safe and effective first line strategy, rather than colectomy.
IBD Dysplasia Acronyms:
IBD (inflammatory bowel disease), NP-CRD (Nonpolypoid colorectal dysplasia), SCENIC (Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients International Consensus), EMR (endoscopic mucosal resection), ESD (endoscopic submucosal dissection), SSA (sessile serrated adenoma), CRC (colorectal cancer), SEC (serrated epithelial change), HGD (high grade dysplasia)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 11,
2023
Received in revised form:
December 17,
2022
Received:
October 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
