Endoscopic resection of colitis-associated neoplasia: A scoping review

Table 1 Summary of key studies on polypectomy in ulcerative colitis

Ref.	Patients (n)	Lesion type	Polypectomy outcome	Cancer risk post-polypectomy	Recommendation
Rubin et al[5], 1999	48	Dysplastic polyps in UC	48% developed new polyps; no flat dysplasia or cancer in follow-up	2% (1 case within polyp)	Polypectomy with surveillance
Odze et al[6], 2004	34	Adenoma-like DALM	62.5% recurred; 1 case of adenocarcinoma	About 3%	Polypectomy if lesion well-circumscribed
Vieth et al[7], 2006	148	Sporadic adenomas	4.6% had distant neoplasia; 2.3% carcinoma	2.3%	Adequate if followed by endoscopic monitoring
Engelsgjerd et al[9], 1999	Case series	Adenoma-like DALMs	Similar profile to sporadic adenomas	Minimal	Supports conservative management
Kisiel et al[8], 2012	77	Polypoid dysplasia	13% developed cancer/flat dysplasia	13% over 5 years	Requires close follow-up
Schaus et al[10], 2007	23	Ileal pouch polyps	91.3% inflammatory; 8.7% dysplastic/malignant	8.7%	Polypectomy + symptom monitoring

DALM: Dysplasia-associated lesion or mass; UC: Ulcerative colitis.

Table 2 Studies evaluating endoscopic mucosal resection in ulcerative colitis

Ref.	Patients (n)	EMR type	Lesion type	Key outcomes	Comments
Hurlstone et al[11], 2007	712	Conventional EMR	Paris 0-II, ALM, LST	93% en bloc; 2.4% recurrence; no perforations	Validated safety and efficacy in UC
Moyer et al[12], 2024	16	Distal cap EMR	Non-lifting dysplasia	75% complete resection; 0 SAEs; thermal margin ablation used	Ideal for fibrotic/adherent lesions
Hosotani et al[2], 2022	1	UEMR	Flat adenoma with fibrosis	Complete R0 resection; no complications	First UEMR case in UC with fibrosis
Takabayashi et al[13], 2022	1	UEMR	Lesion over ulcer/tattoo	En bloc resection; negative margins; safe in fibrotic UC	Demonstrates feasibility in scarred mucosa

EMR: Endoscopic mucosal resection; ALM: Adenoma-like mass; LST: Lateral spreading tumor; SAEs: Serious adverse events; UEMR: Underwater endoscopic mucosal resection; UC: Ulcerative colitis.

Table 3 Multicentre studies evaluating outcomes of endoscopic submucosal dissection in ulcerative colitis

Ref.	Country	n (lesions)	Mean size (mm)	En bloc (%)	R0 (%)	Curative (%)	Fibrosis (%)	Bleed (%)	Perforation (%)	Local recurrence (%)	Metachronous (%)	Surgery (%)
Maselli et al[14], 2024	Italy (ERIN)	96	35	95.8	85.4	83.3	About 73	4.2	8.3	3.1	3.1	11.5
Geyl et al[15], 2025	Italy (JCC)	88	40 (median)	91.0	81.8	79.5	75	8.0	14.8	6.8	Not reported	10.2
Kinoshita et al[17], 2018	Japan	25	22	100.0	76.0	Not stated	100	0.0	4.0	Not stated	Not stated	Indicated if non-curative
Manta et al[16], 2021	Italy	53	35 (median)	100.0	96.2	All R0	54.7 (F1 + F2)	13.2	5.6	0	3.7	3.8 (metachronous cases)
Ngamruengphong et al[18], 2022	United States	45	30 (median)	95.6	75.5	Not stated	73	8.8	2.2	2.6	31	2
Suzuki et al[19], 2017	United Kingdom/Japan	32	33 (median)	91.0	79.0	Not stated	97	3.0	0.0	3.1	9.3	4 (12.5%)

R0: Histologically clear margins; F1/F2: Fibrosis grading; ERIN: Endoscopic Resection Italian Network; JCC: Journak of Crohn’s Colitis.

Table 4 Single centre studies evaluating outcomes of endoscopic submucosal dissection in ulcerative colitis

Ref.	n (lesions)	En bloc (%)	R0 (%)	Curative (%)	Perforation (%)	Local recurrence	Metachronous dysplasia	Notes
Kasuga et al[20], 2021	11	91	82	82	0	0	2 cases (≥ 20 mm)	All ≥ 20 mm lesions
Nishio et al[21], 2021	39	97	97	97	10	0	7% (HGD, LGD)	Compared to EMR
Yang et al[22], 2019	15	93	80	Not stated	0	14.3%	14.3%	Vaguely distinct lesions included
Kochhar et al[23], 2018	7 (5 UC)	86	Not stated	Not stated	0	0	0	United States single-center experience
Lightner et al[24], 2021	25 (16 UC)	Not reported	80	Not stated	4	2/15 (13.3%)	None	40% required surgery later

R0: Histologically clear margins; HGD: High-grade dysplasia; LGD: Low-grade dysplasia; UC: Ulcerative colitis; EMR: Endoscopic mucosal resection.

Table 5 Summary of outcomes from studies using endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid techniques in ulcerative colitis-associated neoplasia

	Alipouriani et al[31], 2025	Hirai et al[32], 2023	Smith et al[33], 2008	Pal et al[26], 2022
Setting	Tertiary United States center	14 Japanese centers	United Kingdom single center	Tertiary center, India
Patients (n)	50	336	67	6
Lesions	ESD (n = 38), ESD + EMR (n = 11), EMR (n = 1)	ESD (n = 96), EMR (n = 142)	Hybrid ESD-assisted EMR	EMR (n = 5), ESD (n = 1)
En bloc resection (%)	68%	ESD: 97%, EMR: 89%	ESD-EMR: 78%	83.3%
R0 resection (%)	Not specified	Not specified	94% (en bloc subset)	83.3%
Perforation rate	2%	ESD: 6.3%, EMR: 0%	3%	None
Recurrence (%)	18%	Local: 2.7%, metachronous: 6.1%	Local: 7%, metachronous: 0%	1 case residual, treated
Follow-up duration	3 years (median)	34.7 months (median)	18 months (median)	Short-term
Key Findings	ESD and hybrid feasible with minimal complications; recurrence similar across groups	Large multicenter validation of ER in UC; higher perforation with ESD; no difference in recurrence	Hybrid ESD-EMR enables resection in fibrotic ALMs; high R0 and low recurrence	Combined resection feasible in Indian setting; R0 achieved in 5/6; residual lesion managed endoscopically

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; UC: Ulcerative colitis; ALMs: Adenoma like mass; R0: Histologically complete resection.

Table 6 Studies evaluating impact of submucosal fibrosis in endoscopic submucosal dissection on ulcerative colitis associated neopalsia

Parameter	Félix et al[36], 2023	Nishio et al[37], 2024	Ozeki et al[1], 2021	Hayashi et al[38], 2014
Setting	Western center, rectal ESD	UC patients, colonic ESD	Colorectal tumors with fibrosis	Japanese academic center
Sample size	195 lesions	55 lesions	133 lesions	267 lesions
Severe fibrosis (%)	23.1%	49%	72.2%	F2 = 34%
Impact on R0/curative (%)	R0: 61.4%, curative: 54.5%	R0: 93%, Curative: 93%	Shorter procedure time with WP-ESD	En bloc: 95.9%, incomplete: 4.1%
Key predictors	UC, prior EMR, deep SM invasion	UC duration ≥ 10 years, scarring mucosa	Prior treatment, UC	Severe fibrosis, poor operability, SM deep invasion
Comments	Lower resection speed, more hybrid ESD needed	Higher perforation in F2 fibrosis (30%)	WP-ESD reduced time; safety comparable to C-ESD	Severe fibrosis and poor operability independently predicted perforation

UC: Ulcerative colitis; ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection; R0: Histologically clear margins; C-ESD: Conventional endoscopic submucosal dissection; WP-ESD: Water pressure-assisted endoscopic submucosal dissection; SM: Submucosal.

Table 7 Lifting and traction techniques in endoscopic submucosal dissection for ulcerative colitis associated neoplasias

Technique	Key feature	Application context	Advantage
PuraLift[39]	Self-assembling peptide lifting agent	All GI segments, excluded fibrosis cases	Low injection resistance, sustained lift
Multitraction[40]	3-looped clip system for recurrent lesion	UC recurrence with fibrosis	Enables re-entry and dissection in fibrotic bed
Triangulated “Wallet”[41]	Rubber band traction with 3-point clip fixation	Fibrotic rectal lesions in UC	Strong, adaptive perpendicular traction
Double-tunneling[42]	Bilateral flaps with preserved septum (“butterfly”)	Extensive rectal LSTs in UC	Maintains orientation, avoids flap rolling
PCM[43]	Submucosal pocket dissection under fibrosis	Residual dysplasia post-EMR + inflammation	Isolates fibrotic layer; good for UC mucosa

UC: Ulcerative colitis; EMR: Endoscopic mucosal resection; GI: Gastrointestinal; LSTs: Laterally spreading tumors; PCM: Pocket creation method.