Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

P165. Endoscopic treatment of dysplasia in ulcerative colitis – median term outcome

A. Ignjatovic1, J. Landy2, Z. Tsiomolous2, S. Thomas-Gibson2, A.L. Hart2, B.P. Saunders2

1John Radcliffe Hospital, Oxford, United Kingdom; 2St Mark's Hospital, Harrow, United Kingdom

Background: Until recently a finding of low grade dysplasia within a segment of colitis was an indication for colectomy. However, recent literature suggests that well circumscribed lesions could be managed by endoscopic resection and continued surveillance.

Objectives: To evaluate the median term outcomes of patients with colitis who have had an endoscopic resection of dysplasia within the segment of colitis.

Methods: Patients who had a surveillance colonoscopy for colitis between 2003 and 2008 and had an endoscopic resection of a dysplastic lesion were retrospectively identified from the endoscopic database. Those who had a follow-up >24 months were included. Colonoscopy and histopathology reports and clinical notes were reviewed.

Results: Nineteen patients (16 male; median age 69, IQR 60.5–73) meeting the criteria were included. 17 had pancolitis and 2 distal colitis, with median disease duration of 27 yrs (IQR 18.5–33.5). Median lesion size was 8 mm (IQR 6.5–20) and 18/19 lesions were sessile (Is = 11, IIa = 7). Two were removed with ESD and the 17/19 with EMR technique. Histology revealed LGD in 16 lesions, HGD in 3–6 lesions were histologically favoured to be DALMs rather than ALMs. Median follow-up was 33 months (IQR 27–43). No cancers were detected in that time and overall 4/19 patients had recurrence at the site of previous resection with median time to recurrence of 6 months (IQR 3–10.75). All recurrences were treated by endoscopic resection. One patient was found to have HGD 16 months later and underwent restorative pan-proctocolectomy in which specimen no cancer was found.

Conclusions: Endoscopically resectable well-circumscribed dysplastic lesions within the segment of colitis could be adequately treated by endoscopic resection and close endoscopic surveillance.