Chronic inflammation predisposes patients with inflammatory bowel disease (IBD) to colorectal cancer. Visible dysplastic lesions without optical characteristics of deeply invasive cancer should be considered for endoscopic resection (ER). However, there is a lack of evidence regarding outcomes of ER in IBD-related dysplastic lesions. This study assesses the curative effectiveness and safety of ER for dysplastic lesions in IBD patients. 

This was a retrospective observational cohort of IBD patients referred to the St. Michael’s Hospital, Toronto, Canada between 2012 and 2025 who underwent ER for management of sporadic polyps or IBD-related dysplasia. The primary outcome was to assess curative resection in this population, defined as; complete (R0) endoscopic removal of the lesion with no adverse histologic features (poor differentiation, lymphovascular invasion, or deep submucosal invasion) and no additional indications for colectomy based on background colitis.

Among 60 patients with colitis-associated neoplasia, the mean age was 61 years (range 38–97), and 66.7% were male. Most had ulcerative colitis (85.0%; Crohn’s disease 15.0%), with a mean disease duration of 17.8 years (0–35); disease type was predominantly extensive colitis (75.0%), with smaller proportions of left-sided colitis (10.0%) and Crohn’s colitis (15.0%). Patients were treated with 5-ASA (58.3%), systemic corticosteroids (5.0%), azathioprine (6.7%), infliximab (8.3%), vedolizumab (1.7%), adalimumab (1.7%), methotrexate (1.7%), or ustekinumab (1.7%), (p=0.016). Neoplasia was most commonly right-sided (43.3%), followed by left-sided (31.7%), rectal (13.3%), and transverse colon lesions (11.7%). Lesions were frequently ≥30 mm (43.3% were 30–50 mm; 6.7% >50 mm), with 35.0% <20 mm and 15.0% 20–29 mm. Morphology were 0–IIa (50.0%), Is (11.7%), 0–IIb (15.0%), mixed IIa+Is (11.7%), pedunculated Ip (5.0%), subpedunculated Isp (3.3%), and IIa+Ic (3.3%); no 0–IIc or 0–III lesions and Paris classification subtype differed significantly between curative and non-curative cases (p=0.011). Almost all lesions did not straddle a haustral fold (98.3%) and had no surrounding active inflammation (98.3%). EMR was selected in (81.7%) of patients, with (13.3%) requiring hybrid techniques and ESD (5.0%), without significant difference by curative status (p=0.295). Overall technical success was 90.0% and was universal in the curative cohort (100%, p<0.0001). En bloc resection and R0 resection were achieved in 25.0% and 26.7% of all lesions, respectively. Histopathology showed tubular adenoma (28.3%), sessile serrated lesions (20.0%), tubulovillous adenoma (23.3%), hyperplastic/inflammatory polyps (18.3%), and UCassociated neoplasia (10.0%), with a significant difference in histologic distribution between groups for curative resection (p=0.001). By Vienna classification, 46.7% had low-grade dysplasia, 20.0% high-grade dysplasia, 11.7% indefinite dysplasia, 20.0% were negative for dysplasia, and 1.7% had submucosal invasive carcinoma; the distribution differed between curative and non-curative resections (p=0.024). Intra-procedural bleeding requiring endoscopic intervention occurred in 15.0% and perforation in 1.7%, with no delayed bleeding or perforation events. Four patients (6.7%) ultimately underwent colectomy, including 2 (3.8%) with prior curative resections (p=0.013), at a median of 13.5 months (range 3–16) after index polypectomy. Surveillance colonoscopy was performed in 31 patients (55.4%), at a median of 13 months (4–108) from index resection; recurrence at the resection site was detected in 8 patients (14.3%). 

Endoscopic resection of colitis-associated neoplasia can be performed with high technical success, curative resection rates, and recurrence outcomes that are comparable to those reported for non-IBD lesions. Our data suggest that, in experienced hands, ER does not appear to be limited by the presence of colitis itself; rather, success is driven by lesion factors such as size, morphology, and histology. Clinically, this supports treating well-demarcated, endoscopically resectable lesions in IBD using standard advanced resection strategies, reserving colectomy for patients with high-risk histology, unresectable lesions, or diffuse colitis-associated dysplasia.