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Endoscopic Submucosal Dissection for visible dysplasia treatment in ulcerative colitis patients: cases series and systematic review of literature.

BACKGROUND AND AIMS
Ulcerative colitis (UC) patients are at increased risk of developing colorectal cancer due to chronic inflammation. Endoscopic submucosal dissection (ESD) allows removal of non-invasive neoplastic lesions in colon, but only few data are available on its efficacy in UC patients.


METHODS
Data of consecutive UC patients diagnosed with visible dysplastic lesions in the colon who underwent ESD were evaluated. The en bloc removal, R0 resection and complications rates were calculated. Local recurrence and metachronous lesions during follow-up were computed. Systematic review of literature with pooled data analysis was performed.


RESULTS
A total of 53 UC patients (Age: 65 years; range 30-74; M/F: 31/22), underwent ESD procedure. The en bloc resection rate was 100%, and the R0 resection was 96.2%. Bleeding occurred in 7 (13.2%) patients, and perforation in 3 (5.6%) cases, all treated at endoscopy. No recurrence was observed, whilst 2 metachronous lesions were detected. Data of other 6 studies (4 Asian and 3 European) were available. By pooling data the en bloc resection was successful in 88.4% (95% CI = 83.5-92) out 216 lesions and 91.8% (95% CI = 87.3-94.8) out of208 patients. The R0 resection was achieved in 169 ESDs, equivalent to a 78.2% (95% CI = 72.3-83.2) rate for lesions and 81.3% (95% CI = 75.4-86) for patients. No difference between European and Asian series was noted.


CONCLUSIONS
This pooled-data analysis pointed out that ESD is a suitable tool for safely and properly removing non-invasive neoplastic lesions on colonic mucosa of selected UC patients.