ESD for high-risk colorectal colitis-associated neoplasia in IBD

Endoscopic submucosal dissection (ESD) has emerged as a highly effective and safe treatment for high-risk colorectal colitis-associated neoplasia (HR-CAN) in patients with inflammatory bowel disease (IBD), according to a multicenter Italian study. HR-CAN in IBD patients, particularly those with long-standing ulcerative colitis or colonic Crohn's disease, poses a significant risk for colorectal cancer and presents unique challenges due to chronic inflammation, scarring, and altered anatomy.

The study included 91 IBD patients with 96 HR-CAN lesions, with an average lesion size of 35 mm. Most lesions exhibited high-grade dysplasia or early adenocarcinoma. Conventional ESD was performed in 82% of cases, while 18% underwent hybrid ESD (hESD). Despite the complexity of the lesions, the outcomes were excellent. En bloc resection (complete removal of the lesion in one piece) was achieved in 95.8% of cases, and R0 resection (clear margins) was successful in 85.4%. Curative resection, meaning no further surgery was needed, was achieved in 83.3% of patients.

Adverse events were low (12.5%) and managed non-invasively. During a mean follow-up of two years, local recurrence and metachronous lesion rates were only 3.1% each, showing durable outcomes. Approximately 11.5% of patients required surgery post-resection, often for reasons unrelated to ESD.

This study underscores that ESD is a highly promising, minimally invasive option for managing HR-CAN in IBD patients, providing strong long-term outcomes, low recurrence rates, and reduced need for surgical interventions.