P0617 Feasibility and safety of endoscopic submucosal dissection in inflammatory bowel disease (ESDEUR-IBD): an interim analysis of European retrospective study

Abstract

Background
Colectomy is the primary treatment for dysplastic lesions in inflammatory bowel disease (IBD). Since the development of advanced endoscopic techniques, the management of dysplasia is evolving. Endoscopic submucosal resection (ESD) could be used in selected cases at referral centres as an alternative to colectomy. However, the feasibility and safety in IBD remains limited. Main aim: To evaluate en-bloc resection rate and the need of colectomy due to ESD failure in IBD. Secondary aims: to assess the complications of ESD, the local recurrence of dysplastic lesions, the presence of synchronous and metachronous lesions and the risk of IBD relapse following the procedure.

Methods
Multicentre, retrospective study of IBD patients who underwent ESD for suspected colonic dysplastic lesions at least one month before the inclusion date. Patients with total colectomy before ESD, invisible dysplasia at the time of ESD, or pregnancy were excluded. En-bloc resection rate and colectomy due to ESD failure at the short term were evaluated by logistic regression analysis. The risk of IBD relapse was evaluated by Cox regression analysis.

Results
Forty-eight patients from 16 centres were included: 36 with ulcerative colitis, 9 with Crohn’s disease and 2 with IBD-unclassified. The mean age at ESD was 63 years (SD 13). The majority of the lesions (n=28, 60%) were located in rectum. Forty lesions (87%) were located in areas previously inflamed. En-bloc and R0 were achieved in 45 (94%) and 37 patients (77%), respectively. Colectomy due to ESD failure was required in 4 patients (8.3%) (Figure 1A). No risk factors were associated with colectomy in multivariable analysis, including inflammatory activity, IBD treatments or characteristics of the lesions. Complications occurred in 16 patients (33%): 6 required pharmacologic therapy, 5 needed endoscopic or radiologic intervention, and 2 underwent surgery (Table 1). No deaths were reported.
At least one surveillance colonoscopy after ESD was performed in 35 patients (73%). Local recurrence was observed in 2 patients while other dysplastic lesions were detected in 9 (29%) during the follow-up (median 2.5 years, IQR 0.5-4). All of these lesions were removed endoscopically. Synchronous and metachronous lesions were identified in 4 (25%) and 7 patients (26%), respectively. IBD relapse occurred in 8 patients during the follow-up, with an incidence rate of 7% person-year (CI 95%:3-15) (Figure 1B).

Conclusion
ESD avoids colectomy in 80% of IBD patients with dysplastic lesions. One-third of the patients experienced complications, all of them resolved with no sequelae. Given the risk of new dysplastic lesions, ongoing monitoring with surveillance colonoscopies is recommended.
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