Endoscopic Resection of Visible Precancerous Lesions in Inflammatory Bowel Disease
Notice bibliographique
Résumé
Aims Chronic inflammation predisposes patients with inflammatory bowel disease (IBD) to a higher risk of colorectal cancer. When dealing with visible dysplastic lesions without optical characteristics of deeply invasive cancer, endoscopic resection (ER) is preferred over surgical resection. Despite this, there is a lack of conclusive evidence regarding the specific outcomes of ER in managing dysplastic lesions within the context of IBD. This study aims to assess the effectiveness and safety of ER for visibly dysplastic lesions in IBD patients. Methods This retrospective study assessed IBD patients referred to the St. Michael’s Endoscopy Unit between 2012 and 2023 who underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) or hybrid EMR-ESD (hESD), for management of sporadic polyps or IBD-related dysplasia. The primary focus was on evaluating rates of en-bloc resection, R0 resection, adverse events (AEs), specifically bleeding and perforation and recurrence at surveillance colonoscopy (SC1). Results Overall, a total of 46 patients underwent endoscopic resection with 58 total lesions removed. The majority, 49 (84%) were removed by EMR, 3 (5.1%) by ESD and 6 (10.3%) by hESD. UC was the most common type of IBD with 77.8% of patients having UC compared to only 15.5% having CD. The majority of patients had extensive colitis (61.5%). The most commonly used medication was 5ASA (55%), followed by biologics (21.7%) and 15.2% of patients reported using no medication. In the EMR group (N=49), dysplastic lesions were most frequently located on the right-sided (52.1%). In the ESD group (N=3), all lesions were left-sided. The majority of lesions (84.4%) had no surrounding disease activity, while 10.3% had mild surrounding activity. Mean lesion size was larger in ESD (38.3 mm) compared to EMR (24.0 mm) and the hybrid approach (25.4 mm). Technical success rates were high overall (87.9%). En-bloc resection rates were 66.7% in the ESD group and 26.5% in the EMR group. R0 resection rates were 25.9% overall. There was only one perforation in the EMR group which was managed endoscopically (1.7%). Nine patients underwent non-emergent surgical resection following multi-disciplinary review of their pathology results. Histologic findings included a minority of ulcerative colitis-associated neoplasia (UCAN) with LGD (6.9%), and UCAN with HGD (3.4%). The majority of lesions were sporadic, with 34 (58.6%) showing LGD and 10 (18.5%) showing HGD. Thirty post-resection SC1s were preformed in this cohort and the recurrence rate was 26.7%. Conclusions This study provides insights into outcomes of ER in IBD patients with dysplasia from an academic centre with expertise in advanced resection. The technical success for ER of these lesions was high, but the recurrence rates were higher than in a non-IBD population. The patients lost to follow up and the timeframe of recurrence prior to the use of adjunctive therapies, would have overestimated recurrences in this cohort. The complication rates were low, suggesting that ER of these lesions is feasible and safe appropriate patients with IBD. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».