Alipouriani Ali, Holubar Stefan D, Erozkan Kamil, Schabl Lukas, Sommovilla Joshua, Valente Michael, Steele Scott R, Gorgun Emre
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, United States.
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, United States.
J Gastrointest Surg. 2025 Feb;29(2):101876. doi: 10.1016/j.gassur.2024.101876. Epub 2024 Nov 7.
Endoscopic resection of visible dysplastic lesions in patients with inflammatory bowel disease (IBD) is an alternative to colectomy. The endoscopic techniques that can be used include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and ESD combined with EMR. These endoscopic approaches may allow organ preservation in patients with IBD. This study aimed to evaluate the outcomes of endoscopic resection, including EMR, ESD, and ESD combined with EMR, for the treatment of colorectal dysplasia in patients with IBD.
This was a retrospective review of patients with IBD who underwent endoscopic resection for colorectal dysplasia at our tertiary care center between 2014 and 2023. Patients were identified via a search of our endoscopy database. Medical records were reviewed to collect data on patient demographics, IBD history, details of endoscopic technique, procedural factors, final pathology results, and outcomes, including recurrence of dysplasia.
A total of 50 patients with IBD who underwent endoscopic resection were included in the study, with 38 ESD cases, 11 ESD combined with EMR cases, and 1 EMR case. The median age was 62 years, (IQR, 54-68), and 34 patients (68%) were male. The median body mass index was 27.6 kg/m (IQR, 24.8-31.7). The underlying diagnoses were ulcerative colitis in 33 patients (66%) and Crohn's disease in 17 patients (33%). The median disease duration was 27.5 years (IQR, 8-30). Polyp locations were distributed as follows: right colon, rectum, left colon, transverse colon, and cecum, with 9 polyps (18%) in each area. The median procedure time was 47.5 min (IQR, 31.2-73.7). En bloc resection was performed in 34 patients (68%), and piecemeal resection was performed in 16 patients (32%). On pathology, the median lesion size was 23.5 mm (IQR, 20.2-40.0). High-grade dysplasia was found in 7 patients (14%), whereas low-grade dysplasia was found in 15 patients (30%). During a median follow-up period of 3 years, 18% of patients experienced recurrence. No significant difference in recurrence rates was observed between the ESD and ESD combined with EMR groups.
Endoscopic resection, including EMR, ESD, and ESD combined with EMR, is an effective treatment of visible dysplastic lesions and is a safe alternative to colectomy in patients with IBD. In this cohort, favorable short-term outcomes were observed after endoscopic resection.
炎症性肠病（IBD）患者可见发育异常病变的内镜切除是结肠切除术的一种替代方法。可使用的内镜技术包括内镜黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）以及ESD联合EMR。这些内镜方法可能使IBD患者保留器官。本研究旨在评估内镜切除（包括EMR、ESD以及ESD联合EMR）治疗IBD患者大肠发育异常的疗效。
这是一项对2014年至2023年期间在我们三级医疗中心接受大肠发育异常内镜切除的IBD患者的回顾性研究。通过检索我们的内镜数据库识别患者。查阅病历以收集患者人口统计学、IBD病史、内镜技术细节、手术因素、最终病理结果以及包括发育异常复发在内的结局数据。
共有50例接受内镜切除的IBD患者纳入研究，其中ESD病例38例，ESD联合EMR病例11例，EMR病例1例。中位年龄为62岁（四分位间距，54 - 68岁），34例患者（68%）为男性。中位体重指数为27.6 kg/m（四分位间距，24.8 - 31.7）。基础诊断为溃疡性结肠炎33例（66%），克罗恩病17例（33%）。中位病程为27.5年（四分位间距，8 - 30年）。息肉部位分布如下：右半结肠、直肠、左半结肠、横结肠和盲肠，每个部位各有9个息肉（18%）。中位手术时间为47.5分钟（四分位间距，31.2 - 73.7分钟）。34例患者（68%）进行了整块切除，16例患者（32%）进行了分片切除。病理检查中，中位病变大小为23.5毫米（四分位间距，20.2 - 40.0毫米）。7例患者（14%）发现高级别发育异常，15例患者（30%）发现低级别发育异常。在中位随访3年期间，18%的患者出现复发。ESD组和ESD联合EMR组之间复发率无显著差异。
内镜切除，包括EMR、ESD以及ESD联合EMR，是治疗可见发育异常病变的有效方法，并且是IBD患者结肠切除术的安全替代方案。在该队列中观察到内镜切除后良好的短期结局。
