P517 Endoscopic mucosal resection (EMR) in treatment of colitis associated neoplasia (CAN): a single-centre experience from Leuven, Belgium

Abstract

Abstract Background Endoscopic resection has been recommended as preferable therapeutic approach for colitis associated neoplasia (CAN) in inflammatory bowel disease (IBD) patients. However, endoscopic resection of these lesions can be challenging due to ongoing inflammation, mucosal scarring, and submucosal fibrosis. We report long-term, single centre experience on performance of endoscopic mucosal resection (EMRs) for treatment of CANs . Methods Hospital electronic database was searched in order to identify all the patients diagnosed with CANs in period 01.01.2009-30.09.2023. Data on the lesion characteristics, therapeutic approach, treatment outcomes and follow-up were collected and used for the descriptive analysis. Results During the study period 32 CANs have been treated with EMR in 19 patients. Mean diameter of the lesion was 18.2±9.09mm (8-50mm). Nine lesions were removed en-bloc (28.1%) while 23 (71.9%) were removed piece meal. One EMR (3.1%) was associated with post-procedural bleeding, which was treated endoscopically by the use of caograsper. Another 2 EMRs (6.2%) were associated with intraprocedural perforations which were resolved by placement of the endoclips. Histopahtological examination disclosed adenomas with low grade dysplasia in 19 lesions (59.4%), adenomas with high grade dysplasia in 7 lesions (21.9%), sessile serrated lesion with high grade dysplasia in one lesion (3.1%) and sessile serrated lesion without dysplasia in 4 lesions (12.5%). One lesion (3.1%) was identified as adenocarcinoma with deep submucosal invasion and patient was referred to surgery. All the other patients were subjected to follow-up, during which 4 cases of local recurrence at the site of resection were observed (12.5%), of which 3 were treated with new EMR while one was referred to surgery. Apart from recurrent lesions, six metachronous CANs were observed during the follow-up in 3 patients (15.8%), all removed by EMR and included in this analysis. All together 2 out of 19 patients (10.5%) included in the study underwent colorectal surgery for CAN treatment. Conclusion EMR appears to be safe and effective in treatment of CANs, both in terms of short and long-terms outcomes, as well as need for additional colorectal surgery.