Endoscopic Submucosal Dissection Efficacy, Safety and Feasibility in Patients With Inflammatory Bowel Disease: A Single Center Experience

Abstract

Introduction: Patients with inflammatory bowel disease, both Crohn's disease (CD) and ulcerative colitis (UC), are at a higher risk for getting colorectal cancer and dysplasia. Endoscopic submucosal dissection (ESD), due to its superiority in achieving en bloc resection has replaced endoscopic mucosal resection (EMR) in management of large polyps (>25 mm). Owing to sub mucosal fibrosis in IBD patients, safety and efficacy of ESD has always been a matter of discussion. We would like to report the largest single center case series, reporting the safety, feasibility and efficacy of ESD for curative resection of selected, large, nonpolypoid neoplasms in patients with IBD Methods: A total of 7 patients with IBD were identified from a prospectively maintained database of patients undergoing ESD at our center, between 2014 and 2017. Demographic and clinical data was collected for all patients. ESD was performed by a single operator, using the standard basic ESD technique. Post procedure complications were also noted. Results: Out of 142 patients undergoing colonic ESD, 7 (4.9%) patients had IBD. Five (71.4%) patients were male, with average age being 54.0±17.3 years. Three (42.8%) patients had polyp located in ascending colon, while 1 (14.2%) patient each had polyp located in cecum, transverse colon, splenic flexure and descending colon. Based on final pathology polyps ranged in size from 25 mm to 70 mm, with average size of the polyp being 40.7 mm. Six (85.7%) out of 7 polyps were flat lesions. En bloc resection was achieved in 6 (85.7%) patients. One (14.2%) patient end up requiring laparoscopic assisted resection. Three (42.8%) patients had low grade dysplasia, 3 had high grade dysplasia, with 1 (14.2%) patient having sessile serrated adenoma. No perforations or significant bleeding (requiring hospitalization) was observed in the patients. All patients underwent 6 months surveillance colonoscopy with no recurrence of dysplasia. Conclusion: ESD is safe, effective and feasible in patients with IBD, despite presence of significant submucosal fibrosis.Table: Table. Clinical and Demographic Variables