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Endoscopic Submucosal Dissection for Colitis-Associated Dysplasia

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초록

Dysplasia is a precancerous lesion of colorectal cancer in patients with long-standing inflammatory bowel diseases (IBDs), suchas ulcerative colitis and Crohn’s disease. Recent guidelines suggest endoscopic resection as a key modality for the treatment ofendoscopically resectable dysplasia in patients with colitis. Endoscopic submucosal dissection (ESD) has been suggested as one ofthe therapeutic options for dysplasia that is potentially resectable but not suitable for the conventional endoscopic mucosal resectiontechnique. Several recent studies supported the feasibility of ESD for the treatment of colitis-associated dysplasia in terms of the enbloc and complete resection rates and the risk of procedure-related complications. However, these studies were performed exclusivelyin expert centers. Moreover, the local and metachronous recurrence rates were relatively high, and long-term outcome data are stilllacking. Endoscopists should be highly skilled in colorectal ESD and have an intensive understanding of not only the lesions butalso the conditions of patients with IBDs. Therefore, the decision to perform ESD for colitis-associated dysplasia should be madescrupulously after careful discussion with patients, in collaboration with a multidisciplinary IBD team including physicians, surgeons,and pathologists specialized in IBDs.

Abstract

Dysplasia is a precancerous lesion of colorectal cancer in patients with long-standing inflammatory bowel diseases (IBDs), suchas ulcerative colitis and Crohn’s disease. Recent guidelines suggest endoscopic resection as a key modality for the treatment ofendoscopically resectable dysplasia in patients with colitis. Endoscopic submucosal dissection (ESD) has been suggested as one ofthe therapeutic options for dysplasia that is potentially resectable but not suitable for the conventional endoscopic mucosal resectiontechnique. Several recent studies supported the feasibility of ESD for the treatment of colitis-associated dysplasia in terms of the enbloc and complete resection rates and the risk of procedure-related complications. However, these studies were performed exclusivelyin expert centers. Moreover, the local and metachronous recurrence rates were relatively high, and long-term outcome data are stilllacking. Endoscopists should be highly skilled in colorectal ESD and have an intensive understanding of not only the lesions butalso the conditions of patients with IBDs. Therefore, the decision to perform ESD for colitis-associated dysplasia should be madescrupulously after careful discussion with patients, in collaboration with a multidisciplinary IBD team including physicians, surgeons,and pathologists specialized in IBDs.

참고문헌 (54)

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