Endoscopic Management of Complex Lesions in Patients With Inflammatory Bowel Disease

Abstract

Patients with inflammatory bowel disease (IBD) have a higher risk of developing colitis-associated dysplastic lesions. Surveil-lance colonoscopy with endoscopic imaging techniques such as chromoendoscopy has been suggested. However, complex dysplastic lesions of larger size, challenging location behind folds, and nonpolypoid morphology defy standard polypectomy techniques and require advanced management with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). When technically feasible for visible dysplasia with distinct margins, these endoscopic procedures have replaced the traditional approach of surgical management. Recent guidelines support careful endoscopic inspection of the colonic mucosa with high-definition colonoscopes and the application of imaging techniques such as chromoendoscopy to enhance lesion detection and characterization as well as to help determine whether endoscopic management is an effective alternative to colectomy. Endoscopic resection techniques such as EMR and ESD have become key modalities in the management of endoscopically resectable dysplasia in patients with IBD.

Keywords: Inflammatory bowel disease; dysplasia; endoscopic mucosal resection; endoscopic submucosal dissection; surveillance.

Figure 1.

High-grade dysplastic lesion in a patient with IBD pre-EMR (A) and post-EMR (B). EMR, endoscopic mucosal resection; IBD, inflammatory bowel disease.

Figure 2.

A: White-light high-definition view of a low-grade dysplastic lesion in a patient with IBD. B: Narrow-band imaging of the lesion. C: The lesion undergoing EMR. D: The post-EMR site. EMR, endoscopic mucosal resection; IBD, inflammatory bowel disease.