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Endoscopic Submucosal Dissection for Colitis-Associated Dysplasia.

Dong-Hoon Yang1, Imelda Rey2

  • 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Clinical Endoscopy
|March 28, 2019
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Summary

Endoscopic submucosal dissection (ESD) shows feasibility for treating precancerous colorectal dysplasia in inflammatory bowel diseases (IBD). However, high recurrence rates and limited long-term data necessitate expert skills and multidisciplinary IBD team collaboration.

Keywords:
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Area of Science:

  • Gastroenterology
  • Oncology
  • Colorectal Surgery

Background:

  • Dysplasia is a precancerous lesion for colorectal cancer in patients with long-standing inflammatory bowel diseases (IBD).
  • Endoscopic resection is recommended for treatable dysplasia in colitis patients.
  • Endoscopic submucosal dissection (ESD) is an option for dysplasia not suitable for conventional endoscopic mucosal resection.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of endoscopic submucosal dissection (ESD) for colitis-associated dysplasia.
  • To assess en bloc resection rates, complete resection rates, and procedure-related complications.
  • To highlight the need for specialized expertise and multidisciplinary collaboration in IBD patient care.

Main Methods:

  • Review of recent studies on ESD for colitis-associated dysplasia.
  • Analysis of en bloc and complete resection rates.
  • Assessment of procedure-related complications, local recurrence, and metachronous recurrence.

Main Results:

  • Recent studies suggest ESD is feasible for colitis-associated dysplasia, with good en bloc and complete resection rates.
  • Procedure-related complication risks appear acceptable in expert centers.
  • Local and metachronous recurrence rates were relatively high, and long-term outcome data are lacking.

Conclusions:

  • ESD is a potential treatment for dysplasia in IBD patients, but requires highly skilled endoscopists.
  • High recurrence rates and limited long-term data necessitate cautious application.
  • Careful patient selection, discussion, and multidisciplinary IBD team collaboration are crucial for optimal decision-making.