Journal of Crohn's & colitis
August 1, 2026 · via Europe PMC
Efficacy, safety, and outcomes of endoscopic submucosal dissection for inflammatory bowel disease-associated colorectal neoplasia: a systematic review and meta-analysis comparing Asian and Western outcomes.
Martins M, Nunes MV, Macedo G, +17 more, Morais R.
AI summary — for doctors, generated from the abstract only
Pooled data suggest endoscopic submucosal dissection is feasible for IBD-associated colorectal neoplasia, with similar outcomes in Asian and Western centers but low certainty of evidence.
What was studied
A systematic review and meta-analysis of 20 studies (565 patients, 732 lesions) on ESD for colorectal neoplasia in patients with IBD.
Key findings
- En-bloc resection 95.7%, R0 84.6% and curative resection 83.9%
- Post-procedural bleeding 7.0% and perforation 7.9%
- Local recurrence 5.3%; additional surgery needed in 13.3%
- No differences between Asian and Western studies
- GRADE certainty low for four outcomes and very low for the rest
Clinical relevance
May inform discussion of endoscopic versus surgical management of IBD-associated dysplasia, but the very low certainty limits firm conclusions.
Who should care
Limitations
Pooled observational studies with substantial heterogeneity and low to very low certainty of evidence.
ESD looks feasible in IBD-associated neoplasia, though the evidence base is weak.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction
Endoscopic submucosal dissection (ESD) is increasingly being adopted worldwide for the treatment of colorectal neoplasia. However, its role in patients with inflammatory bowel disease (IBD) remains debatable, due to chronic inflammation-related fibrosis, potentially affecting outcomes. This study aimed to assess the efficacy and safety of ESD for colorectal neoplastic lesions in IBD patients, comparing Asian and Western settings.
Methods
A systematic review was conducted by searching MEDLINE and Web of Science until January 2025, in accordance to MOOSE guidelines. We included primary studies reporting ESD performance in IBD patients. We performed random-effects meta-analysis for several outcomes, including en-bloc, R0, and curative resection rates, frequency of adverse events (post-procedural bleeding and perforation), local recurrence, and need for additional surgery after ESD. Certainty of evidence was assessed using GRADE.
Results
We included 20 studies (565 patients and 732 lesions). The meta-analytical frequencies of en-bloc, R0, and curative resection rates were 95.7% (95% CI = 93.5-97.9%; I2 = 60.1%), 84.6% (95% CI = 79.4-90.1%; I2 = 68.9%), and 83.9% (95% CI = 76.3-92.4%; I2 = 75.9%), respectively. Postprocedural bleeding and perforation occurred in 7.0% (95% CI = 4.4-11.2%; I2 = 16.9%) and 7.9% (95% CI = 5.3-11.9%; I2 = 2.4%) of cases, respectively. Local recurrence frequency was 5.3% (95% CI = 3.5-7.9%; I2 = 0%). The meta-analytical need for additional surgery was 13.3% (95% CI = 9.5-18.1%; I2 = 42.5%). No differences were found between Asian and Western studies for any outcome. The certainty of evidence was considered "low" in four outcomes and "very low" in the remaining outcomes.
Conclusion
ESD may be feasible and safe for treating IBD-associated colorectal neoplasias, but the available evidence is limited. Similar results were observed between Asian and Western studies.
DOI
10.1093/ecco-jcc/jjag082
PMID
42609137
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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