Advanced diagnostic and resection endoscopic techniques in managing colitis-associated neoplasia: standard of care or still utopia?

Patients with long-standing inflammatory bowel disease (IBD) are at increased risk of developing colitis-associated neoplasia (CAN), requiring a comprehensive approach from surveillance to endoscopic management. This narrative review provides an integrated overview of the entire pathway, including surveillance strategies for dysplasia detection, characterization of lesion types, and selection of appropriate resection techniques. Real-life examples and a proposed step-up approach are presented to guide clinical practice. The choice of endoscopic resection technique depends on lesion size, morphology, and the degree of fibrosis. Conventional EMR is suitable for small, lifting lesions, while ESD is preferred for larger or fibrotic lesions to achieve en bloc resection. In addition, emerging approaches—like underwater techniques—can also provide valuable options in complex cases. However, integrating effective surveillance with personalized resection techniques is essential to improve outcomes and reduce the need for surgery in patients with IBD-associated neoplasia.