title: Curative endoscopic submucosal dissection of large nonpolypoid superficial neoplasms in ulcerative colitis (with videos).
abstract: BACKGROUND
  Endoscopic resection of superficial neoplasms in inflammatory bowel disease (IBD) is appropriate if a complete resection can be achieved. However, EMR is ineffective for large, nonpolypoid neoplasms in IBD due to submucosal fibrosis, and no data are available on the efficacy of endoscopic submucosal dissection (ESD).
  
  
  OBJECTIVE
  To assess ESD feasibility and efficacy for large, nonpolypoid neoplasms in patients with IBD.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Multicenter: Italian and Japanese centers.
  
  
  METHODS
  Consecutive patients with long-standing ulcerative colitis and a superficial nonpolypoid neoplasm, >20 mm within the colitic mucosa.
  
  
  METHODS
  Neoplasm characterization and delineation by chromoscopy and narrow-band imaging. ESD performed according to the standard technique.
  
  
  METHODS
  Feasibility, safety, curative resection rates.
  
  
  RESULTS
  Nine patients with 10 neoplasms were included (7 and 3 in the Italian and Japanese centers, respectively). Neoplasms were laterally spreading tumors-non-granular in 5 cases, in the left side of the colon in 7, had median size of 33 mm, and were associated with scar in 5 cases. Margin delineation was difficult in 5 cases. Submucosal fibrosis was present in 9 cases. ESD was en bloc with negative margins (R0) in 8 cases, and curative in 7. No endoscopic invisible dysplasia or cancer was found during the follow-up (median 24 months, range 6-72 months) at the resection site and elsewhere within the colitic mucosa.
  
  
  CONCLUSIONS
  Small series.
  
  
  CONCLUSIONS
  ESD achieves curative resections in patients with IBD, but the procedure is difficult because of the high prevalence of submucosal fibrosis. Patients need to be accurately evaluated before resection and adhere to strict long-term follow-ups.
authors.affiliation: Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe-ASL Roma H, Albano L, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Iacopini
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe-ASL Roma H, Albano L, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Grossi
authors.affiliation: Pathology Unit, Ospedale S. Giuseppe-ASL Roma H, Marino, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Rigato
authors.affiliation: Digestive Surgical Endoscopy, Catholic University, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: Department of Gastroenterology & Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe-ASL Roma H, Albano L, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Scozzarro
mesh_terms: D000236:Adenoma / Q000209:etiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000150:complications*; D003110:Colonic Neoplasms / Q000209:etiology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D004210:Dissection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome