Endoscopic Resection of Visible Precancerous Lesions in Inflammatory Bowel Disease
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".