P572 Dysplasia in inflammatory bowel disease: Is endoscopic mucosal resection ready for prime-time?
D. Branquinho*, F. Portela, P. Freire, M. Ferreira, S. Mendes, M. Ferreira, C. Sofia
Coimbra University Hospital Centre, Gastroenterology, Coimbra, Portugal
It is well known that the risk for colorectal cancer (CRC) is increased in patients with inflammatory bowel disease (IBD) when compared with the general population, and it depends essentially of the patients’ age, family history, activity, and extent of the disease. Dysplasia is the most reliable marker of malignancy in IBD. Endoscopic mucosal resection (EMR) is starting to play a prominent role in the treatment of these lesions.
In total, 591 colonoscopies executed in the surveillance programme of CRC in IBD patients were included (from 2010 to 2014). Sporadic dysplastic lesions were excluded. Patients with or without adenomas were compared regarding demographics, disease duration, and choice of treatment.
In the study, 50 adenomatous lesions with dysplasia were excised in 45 patients (24 men and 21 women), 36 with ulcerative colitis (proctitis 3, left colitis 17, and pancolitis 16) and 9 with Crohn’s colitis. Their average age was 59.9 ± 14.2, with about 14.3 years of disease duration. Patients with adenomas were significantly older than those without adenomas (59.9 vs 48.6; p = 0.001). Treatment choices were similar between the groups. No differences in gender and duration of disease were noted. All lesions had low-grade dysplasia, except for one serrated adenoma, and were treated by snare polypectomy in 30 cases, and EMR in 25. The average size of the lesion was 14.4 mm (6–40 mm). A complete resection was achieved in 36 procedures (R0 72%). There were no severe complications. The patients were followed for an average of 28.8 months, with at least 1 follow-up exam. There was 1 case of relapse, but it was successfully retreated using EMR, as well. There was no need for surgery and no cases of CRC in this group of patients.
This group of patients with non-sporadic adenomas was significantly older than those without adenomas. Until recently, a significant number of these patients would have been referred for colectomy. EMR is a safe option for treating these lesions, as it has few complications and low relapse rate.