Feasibility and Safety of Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Neoplasia

Background:
Patients with ulcerative colitis (UC) are at an increased risk of UC-associated neoplasia (UCAN). Endoscopic submucosal dissection (ESD) is an acceptable treatment option for patients with UCAN. This study aimed to evaluate the feasibility of ESD for UCAN.
Methods:
Eight patients in the UCAN group and 693 patients in the non-UCAN group who underwent ESD between May 2015 and March 2023 were enrolled. We compared clinical background, tumor size, en bloc resection rate, and complications between the 2 groups. Finally, propensity score matching was used to compare outcomes and complications between the 2 groups. Clinical data were extracted from medical records for this retrospective study.
Results:
The mean size of the resected specimens of the UCAN and non-UCAN groups was 18.1 mm and 27.3 mm, and en-block resection rates were achieved at 100% and 95.6%, respectively. During the median 48.5 months (range, 12-109 months), no local recurrence occurred in the UCAN group. Metachronous high-grade dysplasia occurred in 1 patient, and a total colectomy was subsequently performed. The postoperative bleeding rates in the UCAN and non-UCAN groups were 25% and 2.7%, respectively, and perforation during the procedure occurred in 0% and 1.7% of patients, respectively. The postoperative bleeding rate was higher in the UCAN group than in the non-UCAN group, whereas the perforation rate during the procedure was not significantly different between the UCAN and non-UCAN groups. Concomitant UC is a significant risk factor for postoperative bleeding. After propensity score matching, clinical success rates and procedure-related adverse events were similar between the groups.
Conclusions:
ESD for UCAN is feasible and reasonable without increased complications compared to ESD for non-UCAN. Future research should prioritize the selection of UCAN lesions for safe ESD.