Effectiveness of endoscopic resection for colorectal neoplasms in ulcerative colitis: a multicenter registration study,Gastrointestinal Endoscopy

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Effectiveness of endoscopic resection for colorectal neoplasms in ulcerative colitis: a multicenter registration study
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2023-05-30 , DOI: 10.1016/j.gie.2023.05.058
Minami Hirai ₁ , Shunichi Yanai ₁ , Reiko Kunisaki ₂ , Masafumi Nishio ₂ , Kenji Watanabe ₃ , Toshiyuki Sato ₃ , Soichiro Ishihara ₄ , Hiroyuki Anzai ₄ , Takashi Hisabe ₅ , Shigeyoshi Yasukawa ₅ , Yasuharu Maeda ₆ , Kazumi Takishima ₆ , Akiko Ohno ₇ , Hisashi Shiga ₈ , Toshio Uraoka ₉ , Yuki Itoi ₉ , Haruhiko Ogata ₁₀ , Kaoru Takabayashi ₁₀ , Naohisa Yoshida ₁₁ , Yutaka Saito ₁₂ , Hiroyuki Takamaru ₁₂ , Keisuke Kawasaki ₁₃ , Motohiro Esaki ₁₄ , Nanae Tsuruoka ₁₄ , Tadakazu Hisamatsu ₇ , Takayuki Matsumoto ₁

Affiliation

Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan.
Inflammatory Bowel Disease Centre, Yokohama City University Medical Center, Yokohama, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Japan.
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan.
Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.

Background and Aims

Patients with ulcerative colitis (UC) are at risk of developing colorectal cancer. The feasibility of endoscopic resection (ER) for UC-associated neoplasia has been suggested, but its efficacy and safety remain unclear. We aimed to assess the efficacy and safety of ER for colorectal neoplasms in patients with UC.

Methods

This was a retrospective, multicenter cohort study of patients with UC who initially underwent ER or surgery for colorectal neoplasms between April 2015 and March 2021. Patients who had prior colorectal neoplastic lesions were excluded.

Results

Among 213 men and 123 women analyzed, the mean age at UC onset was 41.6 years, and the mean age at neoplasia diagnosis was 56.1 years for 240 cases of total colitis, 59 cases of left-sided colitis, 31 cases of proctitis, and 6 cases of segmental colitis. EMR was performed for 142 lesions, and endoscopic submucosal dissection (ESD) was performed for 96 lesions. The perforation rate was 2.5% for all 238 lesions removed by ER and 6.3% for the 96 lesions removed by ESD. Among 146 ER lesions followed up with endoscopy, the local recurrence rate was 2.7%. The incidence of metachronous neoplasia after ER was 6.1%. All patients were followed a median of 34.7 months after initial treatment, and 5 died (all surgical cases). Overall survival was significantly higher in the ER group than in the surgery group (P = .0085).

Conclusions

ER for colorectal neoplasms in UC may be acceptable in selected cases, although follow-up for metachronous lesions is necessary.

中文翻译：

内镜切除术治疗溃疡性结肠炎结直肠肿瘤的有效性：多中心注册研究

背景和目标

溃疡性结肠炎（UC）患者有患结直肠癌的风险。内镜切除术（ER）治疗UC相关肿瘤的可行性已被提出，但其有效性和安全性仍不清楚。我们的目的是评估 ER 对 UC患者结直肠肿瘤的疗效和安全性。

方法

这是一项回顾性、多中心队列研究，研究对象为 2015 年 4 月至 2021 年 3 月期间首次接受 ER 或结直肠肿瘤手术的 UC 患者。先前患有结直肠肿瘤病变的患者被排除在外。

结果

在分析的 213 名男性和 123 名女性中，UC 发病的平均年龄为 41.6 岁，瘤形成诊断的平均年龄为 56.1 岁，其中 240 例全结肠炎、59 例左侧结肠炎、31 例直肠炎和 6 例。节段性结肠炎病例。对 142 个病灶进行了 EMR，对 96 个病灶进行了内镜粘膜下剥离术 (ESD)。ER 切除的所有 238 个病灶的穿孔率为 2.5%，ESD 切除的 96 个病灶的穿孔率为 6.3%。内镜随访的146个ER病灶中，局部复发率为2.7%。ER后异时性肿瘤的发生率为6.1%。所有患者在初始治疗后中位随访 34.7 个月，其中 5 例死亡（均为手术病例）。ER 组的总生存率显着高于手术组 ( P = .0085)。