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DOP096. Endoscopic resection of dysplasia in ulcerative colitis - long term outcome

C.H. Choi, A. Ignjatovic Wilson, S. Thomas-Gibson, N. Suzuki, J. Landy, J. Warusavitarne, B. Saunders, A. Hart, St Mark's Hospital, Department of IBD, Colorectal Surgery and Wolfson Unit of Endoscopy, London, United Kingdom

Background

Until recently a finding of dysplasia arising within segment of bowel affected by ulcerative colitis (UC) was an indication for colectomy. However, some dysplastic lesions are discrete and endoscopically resectable. Long-term follow-up data for these selected patients is currently limited. The aim of this study was to evaluate the long term outcomes of patients with UC who have had an endoscopic resection of dysplasia within segment of bowel affected by colitis.

Methods

Patients who had a surveillance colonoscopy for UC at St Mark's Hospital between 1998 and 2008 and had an endoscopic resection of dysplastic lesions were identified from the endoscopic and histology databases. Clinical notes, endoscopy and histopathology reports were reviewed.

Results

One hundred patients met the inclusion criteria (male: female = 66: 34). Eighty-seven had extensive and 13 left-sided colitis, with median disease duration of 24 (IQR 13–33). The median age at disease onset and time of dysplasia diagnosis was 34 (IQR 27–48) and 61 (IQR 54–69) years old, respectively. There were 121 discrete lesions in 100 patients (Ip (60), Is (36), IIa (3), IIb (4), IIa/c (1), LST (1), and 16 were described as “appearance suspicious for DALM (Paris classification not recorded)” but which were also resected endoscopically. Median size was 8 mm (IQR 4–15). Lesions were removed using snare polypectomy (43), EMR (29), hot biopsy (20) or ESD (3) techniques. Histology showed LGD in 111 lesions and HGD in 10 lesions: 36 (30%) favoured UC-associated dysplasia, 56 (46%) favoured adenoma, and 29 (24%) lesions were inconclusive between dysplasia and adenoma. Median duration of follow up was 70 months (IQR 53–89).

Overall, two cancers were detected during that time: one in same and one in distant segment to the previous dysplasia. The proportion of patients who developed dysplasia recurrence was 24% with median duration to recurrence of 41 months (IQR=16–55). Nineteen patients (19%) had recurrence to the same grade of dysplasia that was initially treated: three patients had colectomy (2 LGDs and 1 with no dysplasia), two patients died from unrelated cause, and 14 patients are still on endoscopic follow-up. Four patients (4%) have progressed from LGD to HGD which were all detected during surveillance: three patients had colectomy (Duke's A CRC, LGD, and indeterminate dysplasia, respectively), and one patient refused surgery whose latest colonoscopy showed LGD. One patient was lost in follow up for 5 years and subsequent colonoscopy detected Duke's C cancer.

Conclusion

Patients with endoscopically resectable, well circumscribed dysplastic lesions within the segment of colitis have a good outcome with endoscopic treatment with close surveillance.