Hirai Minami, Yanai Shunichi, Kunisaki Reiko, Nishio Masafumi, Watanabe Kenji, Sato Toshiyuki, Ishihara Soichiro, Anzai Hiroyuki, Hisabe Takashi, Yasukawa Shigeyoshi, Maeda Yasuharu, Takishima Kazumi, Ohno Akiko, Shiga Hisashi, Uraoka Toshio, Itoi Yuki, Ogata Haruhiko, Takabayashi Kaoru, Yoshida Naohisa, Saito Yutaka, Takamaru Hiroyuki, Kawasaki Keisuke, Esaki Motohiro, Tsuruoka Nanae, Hisamatsu Tadakazu, Matsumoto Takayuki
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan.
Inflammatory Bowel Disease Centre, Yokohama City University Medical Center, Yokohama, Japan.
Gastrointest Endosc. 2023 Nov;98(5):806-812. doi: 10.1016/j.gie.2023.05.058. Epub 2023 May 30.
Patients with ulcerative colitis (UC) are at risk of developing colorectal cancer. The feasibility of endoscopic resection (ER) for UC-associated neoplasia has been suggested, but its efficacy and safety remain unclear. We aimed to assess the efficacy and safety of ER for colorectal neoplasms in patients with UC.
This was a retrospective, multicenter cohort study of patients with UC who initially underwent ER or surgery for colorectal neoplasms between April 2015 and March 2021. Patients who had prior colorectal neoplastic lesions were excluded.
Among 213 men and 123 women analyzed, the mean age at UC onset was 41.6 years, and the mean age at neoplasia diagnosis was 56.1 years for 240 cases of total colitis, 59 cases of left-sided colitis, 31 cases of proctitis, and 6 cases of segmental colitis. EMR was performed for 142 lesions, and endoscopic submucosal dissection (ESD) was performed for 96 lesions. The perforation rate was 2.5% for all 238 lesions removed by ER and 6.3% for the 96 lesions removed by ESD. Among 146 ER lesions followed up with endoscopy, the local recurrence rate was 2.7%. The incidence of metachronous neoplasia after ER was 6.1%. All patients were followed a median of 34.7 months after initial treatment, and 5 died (all surgical cases). Overall survival was significantly higher in the ER group than in the surgery group (P = .0085).
ER for colorectal neoplasms in UC may be acceptable in selected cases, although follow-up for metachronous lesions is necessary.
溃疡性结肠炎（UC）患者有患结直肠癌的风险。内镜切除术（ER）用于治疗UC相关肿瘤的可行性已被提出，但其疗效和安全性仍不明确。我们旨在评估ER治疗UC患者结直肠肿瘤的疗效和安全性。
这是一项回顾性、多中心队列研究，研究对象为2015年4月至2021年3月期间因结直肠肿瘤最初接受ER或手术治疗的UC患者。排除既往有结直肠肿瘤性病变的患者。
在分析的213名男性和123名女性中，全结肠炎240例、左侧结肠炎59例、直肠炎31例和节段性结肠炎6例，UC发病的平均年龄为41.6岁，肿瘤诊断的平均年龄为56.1岁。对142个病变进行了内镜黏膜切除术（EMR），对96个病变进行了内镜黏膜下剥离术（ESD）。ER切除的所有238个病变的穿孔率为2.5%，ESD切除的96个病变的穿孔率为6.3%。在146个接受内镜随访的ER病变中，局部复发率为2.7%。ER后异时性肿瘤的发生率为6.1%。所有患者在初始治疗后中位随访34.7个月，5例死亡（均为手术病例）。ER组的总生存率显著高于手术组（P = 0.0085）。
UC患者结直肠肿瘤的ER在某些特定病例中可能是可以接受的，尽管对异时性病变进行随访是必要的。
