Abstract Background Colectomy is the primary treatment for dysplastic lesions in inflammatory bowel disease (IBD). Since the development of advanced endoscopic techniques, the management of dysplasia is evolving. Endoscopic submucosal resection (ESD) could be used in selected cases at referral centres as an alternative to colectomy. However, the feasibility and safety in IBD remains limited. Main aim: To evaluate en-bloc resection rate and the need of colectomy due to ESD failure in IBD. Secondary aims to assess the complications of ESD, the local recurrence of dysplastic lesions, the presence of synchronous and metachronous lesions and the risk of IBD relapse following the procedure. Methods Multicentre, retrospective study of IBD patients who underwent ESD for suspected colonic dysplastic lesions at least one month before the inclusion date. Patients with total colectomy before ESD, invisible dysplasia at the time of ESD, or pregnancy were excluded. En-bloc resection rate and colectomy due to ESD failure at the short term were evaluated by logistic regression analysis. The risk of IBD relapse was evaluated by Cox regression analysis. Results Sixty-nine ESD from 23 centres were included: 55 with ulcerative colitis, 12 with Crohn’s disease and 2 with IBD-unclassified. The mean age at ESD was 63 years (SD 13). The majority of the lesions (n = 35, 50%) were in rectum. Sixty lesions (87%) were in areas previously inflamed. En-bloc and R0 were achieved in 66 (95%) and 53 patients (76%), respectively. Colectomy due to ESD failure was required in 7 patients (10%) (Figure 1A). Complications occurred in 20 patients (28%): 7 required pharmacologic therapy, 6 needed endoscopic or radiologic intervention, and 2 underwent surgery (Table 1). No deaths were reported. At least one surveillance colonoscopy after ESD was performed in 47 patients (67%). Local recurrence was observed in 3 patients while other dysplastic lesions were detected in 33 (47%) during the follow-up (median 1.9 years, IQR 0.4-2.8). All these lesions were removed endoscopically. Synchronous and metachronous lesions were identified in 6 (24%) and 10 patients (21%), respectively. IBD relapse occurred in 10 patients during the follow-up, with an incidence rate of 7% person-year (CI 95%:3-15) (Figure 1B). Conclusion Colectomy was avoided in 90% of IBD patients undergoing ESD for dysplastic lesions. One-third of the patients experienced complications, most of them resolved with no sequelae. Given the risk of new dysplastic lesions, ongoing monitoring with surveillance colonoscopies is recommended. Conflict of interest: Prof. Dr. García, María José: Other: MJ García has received financial support for travelling and educational activities from Janssen, Pfizer, Abbvie, Takeda and Ferring. Fraile, Miguel: No conflict of interest Katinios, Georgios: No conflict of interest Gubbiotti, Alessandro: No conflict of interest Argyriou, Konstantinos: No conflict of interest Neri, Benedetto: no conflicts of interest Elosua Gonzalez, Alfonso: I have served as speaker, consultant for or have received education funding from AbbVie, Johnson and Johnson, Adacyte, Takeda, Faes Farma, and Tillots Pharma. González Partida, Irene: I have received funding for training and/or promotional talks from Amgen, Abbvie, Biogen, Falk, Kern Pharma, Johnson&Johnson, Lilly, Pfizer, Takeda and Tillots. Gavric, Aleksandar: No conflict of interest Loly, Jean-Philippe: No conflict of interest De Castro Parga, Maria Luisa: I declare that I have acted as a speaker for Abbvie, Johnson & Johnson, Takeda, Tillots Pharma and Dr. Falk Pharma. I have received travel or conference attendance grants from Abbvie, Faes, Dr. Falk Pharma, Pfizer, Johnson & Johnson, Takeda, Tillots Pharma and Ferring. Fousekis, Fotios: None Cudero Quintana, Laura: No conflict of interest Suchanek, Stepan: No conflict of interest Caron, Bénédicte: No conflict of interest Llao Guardia, Jordina: I have received financial support from AbbVie, Tillots, Adacyte, Jansen, Alfasigma and Lilly for educational activities. Terán, Álvaro: No conflict of interest Gordillo Abalos, Jordi: No conflict of interest Poortmans, Pieter Jan: No conflict of interest Arranz Hernández, Laura: No conflict of interest López García, Alicia: - I was awarded with the ODISEA Grant from the Spanish Group of Ulcerative Colitis and Crohn’s Disease (GETECCU) in 2024. - Speaker fees from Pfizer, Takeda, AbbVie, Lilly, Chiesi and Johnson and Johnson. - Educational funding from Takeda, AbbVie, Johnson and Johnson. - Support for conference attendance from Kern Pharma, Pfizer, Takeda, ABBVIE, Lilly, Chiesi, Janssen, Ferring, Dr. Falk Pharma, Tillots, and Salvat Ceballos Santos, Daniel: None de María Pallares, Pedro: No conflict of interest Elorza, Ainara: No conflict of interest Ramos Lopez, Laura: L.R. has acted as a speaker or received funding for training from MSD, Abbvie, Adacyte, Takeda, Pfizer, Janssen, and Ferring. Bednarska, Olga: No conflict of interest Savarino, Edoardo Vincenzo: Personal Fees: Takeda, Abbvie, MSD, Janssen, Sofar Manolakis, Anastassios: No conflict of interest Mancone, Roberto: No conflict of interest Albéniz, Eduardo: No conflict of interest de Frutos, Diego: No conflict of interest Vieujen, Sophie: No conflict of interest Rodríguez D´Jesús, Antonio: No conflict of interest Skamnelos, Alexandros: No conflict of interest Schaefer, Marion: No conflict of interest Moscardó Ribas, Amparo: No conflict of interest Truyens, Marie: No conflict of interest García Romero, Diana: No conflict of interest Honrubia López, Raúl: No conflict of interest Rivero Tirado, Montserrat: No conflict of interest
García et al. (Thu,) studied this question.