Objective Ulcerative colitis-associated neoplasia (UCAN) and sporadic neoplasia require different treatment strategies; their differential diagnosis is based on endoscopic findings and biopsy results. However, accurate diagnosis is sometimes difficult. Similarly, it is often challenging to evaluate invasion depth. Recently, their diagnosis has become possible pathologically, following endoscopic UCAN resection. This study investigated whether endoscopic submucosal dissection (ESD) is useful as a treatment or diagnostic (total biopsy) modality for neoplastic lesions within the inflammatory region in patients with ulcerative colitis. Methods We retrospectively reviewed the characteristics, accuracy of endoscopic diagnosis, results of ESD, adverse events, and changes in therapeutic strategy after ESD for 27 neoplastic lesions (15 UCANs and 12 sporadic neoplasias) occurring within the inflammatory region of ulcerative colitis in patients at our institution between January 2016 and September 2023. Results UCANs had significantly more non-polypoid morphology ( P = 0.037) and inflammation around the neoplasia ( P = 0.010). The diagnostic accuracy for low-grade dysplasia was higher in sporadic neoplasias than in UCANs. ESD results ( en bloc resection/R0 resection) were similar between UCANs (100%/86.7%) and sporadic neoplasias (91.7%/83.3%). The incidence of intraoperative perforation and delayed bleeding was comparable. In eight lesions (29.6%), accurate pathological diagnosis via ESD prompted changes in the pre-ESD treatment strategy. Notably, surgical resection was avoided in three lesions (11.1%), including one UCAN lesion reclassified from high-grade dysplasia to low-grade dysplasia and two sporadic neoplasia lesions initially diagnosed as UCANs. Conclusion ESD results of patients with ulcerative colitis were acceptable. ESD may be a useful modality for optimal treatment planning.
Oiwa et al. (Thu,) studied this question.