Comparative outcomes of endoscopic mucosal resection for laterally spreading lesions in inflammatory bowel disease

Varun T Angajala; James L Buxbaum; Jennifer Phan; Jennifer L Dodge; Collin Mayemura; Melissa Ho; Aaron Lit; Christine Tien; Patrick W Chang; Maziar Amini; Sarah Sheibani; Ara B Sahakian

doi:10.1055/a-2369-7980

Comparative outcomes of endoscopic mucosal resection for laterally spreading lesions in inflammatory bowel disease

Endoscopy. 2024 Sep 18. doi: 10.1055/a-2369-7980. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine, Division of Gastrointestinal and Liver Diseases, University of Southern California, Keck School of Medicine, Los Angeles, United States.
² Department of Population and Public Health Sciences, University of Southern California, Los Angeles, United States.

PMID: 39029912
DOI: 10.1055/a-2369-7980

Abstract

Background: The role of endoscopic mucosal resection (EMR) for laterally spreading lesions (LSLs) in inflammatory bowel disease (IBD) remains controversial despite its effectiveness in the general population. We aimed to characterize outcomes of EMR for IBD-associated LSLs compared with controls without IBD.

Methods: We performed a retrospective observational cohort study of patients with IBD who underwent EMR and endoscopic follow-up for LSLs, compared with a control group without IBD. The primary outcome was histologic recurrence. Secondary outcomes included en bloc resection and adverse events. Factors associated with recurrence were identified using multivariate mixed effects logistic regression.

Results: 210 premalignant lesions in 155 patients were included. By histology, 91.0% were adenoma/low grade dysplasia or sessile serrated lesions. Median (IQR) lesion size was 25 (12-30) mm in the IBD group and 20 (12-30) mm in the control group. Recurrence was detected in 30.4% of IBD-associated lesions (7/23) compared with 20.9% of controls (39/187; odds ratio [OR] 2.51, 95%CI 0.59-10.71). En bloc resection was less common in the IBD group (2/23 [8.7%], 95%CI 1.1-28.0) versus controls (106/187 [56.7%], 95%CI 50.4-65.2). After adjusting for lesion size and histology, recurrence appeared more common in patients with IBD compared with controls (OR 3.08, 95%CI 1.04-9.13).

Conclusions: Recurrence of LSLs after EMR appeared to be more frequent in patients with IBD. Given the added complexity, EMR in patients with IBD should be performed in expert centers with close endoscopic surveillance.