Endoscopic resection is feasible for high-grade dysplasia in patients with ulcerative colitis

Abstract

Background

Endoscopic resection (ER) is feasible for treating well-circumscribed dysplasia in patients with ulcerative colitis (UC). However, long-term prognosis of ER for high-grade dysplasia (HGD) in patients with UC remains unclear. We aimed to evaluate the long-term prognoses of ER for HGD compared with low-grade dysplasia (LGD) and verify the feasibility of ER and follow-up with surveillance colonoscopy for HGD.

Methods

An observational, single-center retrospective study included 38 and 22 patients with LGD and HGD who were followed-up with surveillance colonoscopy after ER. We evaluated the cumulative incidence rate of metachronous HGD or colorectal cancer (CRC) and identified the characteristics of metachronous dysplasia.

Results

The median follow-up period was 56 months, and surveillance colonoscopies were performed 3.6 times (mean). The 5-year cumulative incidence rate of HGD/CRC was relatively high in HGD (24.6%) than in LGD (13.7%), but the difference was not significant (p = .16). In HGD cases, six metachronous dysplasia lesions (two LGD and four HGD) were detected 11.6–40.5 months after ER. However, these patients did not progress to CRC. All metachronous lesions were well-circumscribed and with no invisible dysplasia surrounding them; they were ‘endoscopically resectable’ lesions. Two of the four metachronous HGD lesions were treated endoscopically and two, by colectomy. No synchronous HGD or CRC was detected in the colectomy specimens.

Conclusions

Our results suggest that ER and follow-up with surveillance colonoscopy is feasible in patients with HGD when histological complete resection is achieved.

Keywords:

• Endoscopic resection
• high-grade dysplasia
• prognosis
• ulcerative colitis

Author contributions

M.N., K.H., and S.M. contributed to conception and design, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, and final approval of the article; R.K. contributed to conception and design, critical revision of the article for important intellectual content, and final approval of the article; S.C. and Y.I. contributed to histological diagnosis, critical revision of the article for important intellectual content, and final approval of the article. Y.O., A.S., R.I., T.F., R.K., and C.S. contributed to analysis and interpretation of the data, critical revision of the article for important intellectual content, and final approval of the article. The corresponding author had full access to all the study data and had the final responsibility of deciding to submit the article for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.