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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.
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.
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.
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)
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Accepted: January 11, 2023
Received in revised form: December 17, 2022
Received: October 11, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 by the American Society for Gastrointestinal Endoscopy