eP167 - Active Monitoring and Treatment of Squamous Intraepithelial Lesions to Reduce Anal Cancer and Dysplasia – the Tel Aviv Experience

ePoster Presenter(s)

• GA

  Gilad Alon, MD (he/him/his)

  colorectal Surgery Fellow
  Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
  The Cleveland Clinic
  Beachwood, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• yk

  yehuda kariv, n/a

  Director of colorectal surgery unit
  Ichilov hospital, Tel Aviv, Tel Aviv university
  Tel Aviv, Tel Aviv, Israel

  Disclosure information not submitted.

Author(s)

• YB

  Yitzhak Brzezinski Sinai, MD

  Head of the advanced Airway group, department of anesthesia pain and intensive care Tel Aviv Medical
  Tel Aviv University
  Tel Aviv, Tel Aviv, Israel

  Disclosure information not submitted.

Purpose/Background: Anal intraepithelial neoplasia (AIN) is considered a precancerous lesion and may develop to anal squamous cell carcinoma. High resolution anoscopy (HRA) is becoming the standard of care for screening, staging and follow-up of AIN, and can guide management. Treating high grade AIN (HSIL) has been recently shown to reduce cancer rates in high-risk groups. Data on AIN and its management in Israel is limited.

Aim: To evaluate our results following an active approach to monitor and treat anal dysplastic lesions in a dedicated HRA clinic.Methods/Interventions: Patients who underwent at least one HRA procedure from 2014 to 2022 were included. Patients were referred to HRA if dysplastic squamous changes were previously diagnosed in anorectal lesions, or if they were at high-risk to develop such changes. Patients with an initial diagnosis of anal cancer were excluded. HSIL diagnosed with HRA was treated with cautery ablation. Patients were encouraged to have HPV vaccination. We retrospectively analyzed dysplasia and cancer rates during follow-up according to indications to perform HRA.Results/Outcomes: 114 patients (median age 36 (range 16-78), 71% Male, 38% homosexual men, 16% HIV+) underwent 209 HRA procedures (mean 1.83 procedures per patient, range 1-7). Median follow-up was 34 months. HSIL rates in HRA procedures during follow-up and in most recent biopsies in each indication group is shown in the table below. 31 of 38 patients with HSIL in HRA biopsies were treated with 54 ablative procedures. Total HSIL rate (in primary indication and in HRA biopsies) was reduced by 65% (60 to 21 cases). No anal cancer cases were diagnosed during follow-up.Conclusion/

Discussion: An algorithm that involves close monitoring with HRA and ablation of HSIL in high-risk patients may reduce dysplasia and cancer rates.
indication for HRA and dysplasia rates

from HSIL indication to last HRA follow up