Abstract
INTRODUCTION: Patients with longstanding ulcerative colitis (UC) face an increased risk of colorectal cancer, necessitating regular surveillance. Chronic inflammation frequently leads to submucosal fibrosis, making the resection of non-lifting lesions difficult with standard techniques like endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). CASE PRESENTATION: We present a 76-year-old UC patient with a splenic flexure adenoma that was unresectable via EMR/ESD. Given the high surgical risk, the OVESCO system was used, achieving clear margins and avoiding colectomy. CONCLUSION: This case highlights full-thickness resection devices as a minimally invasive alternative for challenging polyps in UC, preserving bowel function while avoiding major surgery or stoma formation.