Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis

  • Talia F. Malik (Department of Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science) ;
  • Vaishnavi Sabesan (Department of Gastroenterology and Hepatology, University of Utah School of Medicine) ;
  • Babu P. Mohan (Department of Gastroenterology and Hepatology, Orlando Gastroenterology PA) ;
  • Asad Ur Rahman (Department of Gastroenterology and Hepatology, Cleveland Clinic Florida) ;
  • Mohamed O. Othman (Gastroenterology and Hepatology Section, Baylor College of Medicine) ;
  • Peter V. Draganov (Department of Gastroenterology, Hepatology, and Nutrition, University of Florida) ;
  • Gursimran S. Kochhar (Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network)
  • Received : 2023.08.11
  • Accepted : 2023.09.27
  • Published : 2024.05.30
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Abstract

Background/Aims: In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD). Methods: Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity. Results: Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%-95.4%; I2=0%), 81.5% (95% CI, 72.5%-88%; I2=43%), and 48.9% (95% CI, 32.1%-65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%-7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%-13%; I2=10%) and 5.3% (95% CI, 3.1%-8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%-18.2%; I2=55%) and 13% (95% CI, 8.5%-19.3%; I2=54%), respectively. Conclusions: ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection.

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References

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