Evaluation of the Efficacy and Safety of ESD for Neoplastic Lesions in the Mucosa of Ulcerative Colitis Patients

Aims In patients with ulcerative colitis (UC), the risk of developing ulcerative colitis-associated neoplasia (UCAN) increases with long-term disease duration, making early detection and safe, effective treatment essential. Endoscopic submucosal dissection (ESD) for UC patients is technically challenging due to submucosal fibrosis, fat deposition, and thin mucosa often observed in these cases. This study aimed to evaluate the efficacy and safety of ESD for neoplastic lesions in UC-affected mucosa at our institution.

Methods Between April 2021 and November 2024, seven patients (eight lesions) with neoplastic lesions arising in UC-affected mucosa underwent ESD. Patient demographics, procedure duration, and pathological diagnoses were analyzed.

Results The study included six males and one female, with a mean age of 60 years (range: 28–76) and a median UC disease duration of 14 years (range: 6–44). The disease phenotype was pancolitis in 87.5% and left-sided colitis in 12.5%, and all cases exhibited a relapsing-remitting disease course. Lesion locations included the cecum (n=2), ascending colon (n=1), transverse colon (n=1), descending colon (n=1), sigmoid colon (n=1), and rectum (n=2). The median tumor size was 28.5 mm (range: 15–70 mm). Background mucosa showed remission in all cases. The mean procedure time was 111.5 minutes (range: 45–210 minutes), and the en bloc resection rate was 100%. All cases were treated using underwater ESD, with no post-procedural complications observed. Pathological diagnoses included adenocarcinoma (n=2), low-grade dysplasia (LGD, n=1), low-grade adenoma (n=1), sessile serrated lesion (SSL, n=2), traditional serrated adenoma (TSA, n=1), and juvenile polyp (n=1).

Conclusions Although this study included a small number of cases, underwater ESD demonstrated safety and efficacy in the treatment of UC-affected mucosa, even in the presence of submucosal fibrosis and fat deposition. Furthermore, in UCAN cases, detailed assessment using NBI magnification endoscopy combined with precise marking enabled successful en bloc resection.

Publication History

Article published online:
27 March 2025