PTH-063 Endoscopic resection of dysplastic lesions in colitis

IntroductionCumulative colon cancer risk is estimated at 2%–18% depending on duration of colitis. Management of flat neoplasia in colitis remains controversial. BSG guidelines recommend colectomy if complete endoscopic resection isn’t guaranteed. Aim of this study was to assess need for surgery in the management of flat neoplasia in colitis.MethodsA multicentre cohort study of all flat neoplasia endoscopically resected in colitis in 5 tertiary European centres from 2008–2017.Results101 flat neoplasia were resected in 85 patients at 5 European centres. Mean age 61 years (range 28–82). Mean size of lesions 34 mm (range 8–120 mm).Abstract PTH-063 Table 1Lesion location KARColon (26) KARRectum (13) EMRColon (54) EMR Rectum (8) Total(101) Recurrence 2 0 5 0 7 Complications 5 0 2 0 7 En-bloc 14 11 33 5 63 Abstract PTH-063 Table 2Fibrosis KARFibrosis (26) KAR No fibrosis(13) EMRFibrosis (15) EMR No fibrosis (47) Total(101) Recurrence 1 1 0 5 7 Complications 5 0 1 1 7 En-bloc 15 10 8 30 63 Abstract PTH-063 Table 3Lesion size KAR0–20 mm KAR>20 mm EMR0–20 mm EMR>20 mm Total Recurrence 0 2 3 2 7 Complications 0 5 1 1 7 En-bloc 4 21 37 1 63 40% of the lesions were treated by KAR. There was no difference in lesion location between EMR and KAR. Lesions >20 mm in size were removed more by KAR than EMR. More lesions removed by KAR (26) had fibrosis compared to EMR (15). 7 complications occurred in the cohort; 3 cases of bleeding and 4 perforations. Bleeding was controlled endoscopically. 3 perforations were managed endoscopically and 1 required surgery. 7/86 (8.1%) lesions with follow up data had recurrence.Multi-variate regression analysis concluded;33. EMR leads to higher recurrence rates, irrespective of size, location and fibrosis (p–value of 0.048)34. KAR leads to higher complication rates in the colon as compared to rectum (p–value of 0.045)35. KAR shows a trend towards better en–bloc resection (p–value 0.063).5 lesions underwent surgery; 3 due to cancer; 1 due to perforation; 1 due to failure of endoscopic resection. Histology; 88 adenoma (low-grade dysplasia), 6 adenoma (high-grade dysplasia), 3 cancers and 4 sessile serrated polyps.ConclusionsThis is the largest reported cohort of endoscopic resection of flat neoplasia in colitis. We demonstrate that both KAR and EMR are feasible in colitis with only 5% of patients requiring surgery. Fibrosis is very common in colitis. Recurrence is higher with EMR and complications higher with KAR. Our data shows that lesions wi