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DOI: 10.1055/a-2115-7797
Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions
Abstract
Background We aimed to evaluate the safety and technical success of an easy-to-use technique that applies underwater cap suction pseudopolyp formation to facilitate the resection of flat lesions or those at the appendiceal orifice or ileocecal valve.
Methods We retrospectively analyzed a register of consecutive cap suction underwater endoscopic mucosal resection (CAP-UEMR) procedures performed at two centers between September 2020 and December 2021. Procedures were performed using a cone-shaped cap, extending 7 mm from the endoscope tip, to suction the lesion while submerged underwater, followed by underwater snare resection. Our primary end point was technical success, defined as macroscopic complete resection.
Results We treated 83 lesions (median size 20 mm; interquartile range [IQR] 15–30 mm) with CAP-UEMR: 64 depressed or flat lesions (18 previously manipulated, 9 with difficult access), 11 from the appendix, and 8 from the ileocecal valve. Technical success was 100 %. There were seven intraprocedural bleedings and two delayed bleedings, all managed endoscopically. No perforations or other complications occurred. Among the 64 lesions with follow-up colonoscopy, only one recurrence was detected, which was treated endoscopically.
Conclusions CAP-UEMR was a safe and effective technique for removing nonpolypoid colorectal lesions, including those arising from the appendiceal orifice or ileocecal valve.
Publication History
Received: 25 January 2023
Accepted after revision: 22 June 2023
Accepted Manuscript online:
22 June 2023
Article published online:
25 July 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
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References
- 1 Buskermolen M, Naber SK, Toes-Zoutendijk E. et al. Impact of surgical versus endoscopic management of complex nonmalignant polyps in a colorectal cancer screening program. Endoscopy 2022; 54: 871-880
- 2 Lee EY, Bourke MJ. EMR should be the first-line treatment for large laterally spreading colorectal lesions. Gastrointest Endosc 2016; 84: 326-328
- 3 Moss A, Bourke MJ, Williams SJ. et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918
- 4 Longcroft-Wheaton G, Duku M, Mead R. et al. Risk stratification system for evaluation of complex polyps can predict outcomes of endoscopic mucosal resection. Dis Colon Rectum 2013; 56: 960-966
- 5 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
- 6 Kim HG, Thosani N, Banerjee S. et al. Effect of prior biopsy sampling, tattoo placement, and snare sampling on endoscopic resection of large nonpedunculated colorectal lesions. Gastrointest Endosc 2015; 81: 204-213
- 7 Vosko S, Gupta S, Shahidi N. et al. Impact of technical innovations in EMR in the treatment of large nonpedunculated polyps involving the ileocecal valve (with video). Gastrointest Endosc 2021; 94: 959-968.e952
- 8 Tate DJ, Desomer L, Awadie H. et al. EMR of laterally spreading lesions around or involving the appendiceal orifice: technique, risk factors for failure, and outcomes of a tertiary referral cohort (with video). Gastrointest Endosc 2018; 87: 1279-1288.e1272
- 9 Binmoeller KF, Weilert F, Shah J. et al. “Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 2012; 75: 1086-1091
- 10 Sanchez JR, Alvarez-Gonzalez MA, Pellise M. et al. Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial. Gastrointest Endosc 2023; 97: 941-951.e2
- 11 Binmoeller KF, Hamerski CM, Shah JN. et al. Underwater EMR of adenomas of the appendiceal orifice (with video). Gastrointest Endosc 2016; 83: 638-642
- 12 Kim HG, Thosani N, Banerjee S. et al. Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video). Gastrointest Endosc 2014; 80: 1094-1102
- 13 Uchima H, Colan-Hernandez J, Binmoeller KF. Peristaltic contractions help snaring during underwater endoscopic mucosal resection of colonic non-granular pseudodepressed laterally spreading tumor. Dig Endosc 2021; 33: e74-e76
- 14 Uchima H, Calm A, Colan-Hernandez J. et al. Cap-suction underwater endoscopic mucosal resection for en bloc resection of nongranular pseudodepressed colonic lesion: a novel technique when conventional snaring is not possible. Endoscopy 2023; 55: E106-E107
- 15 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
- 16 Burgess NG, Bassan MS, McLeod D. et al. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut 2017; 66: 1779-1789
- 17 Tate DJ, Bahin FF, Desomer L. et al. Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions. Endoscopy 2018; 50: 52-62
- 18 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289
- 19 Kobayashi R, Hirasawa K, Ikeda R. et al. The feasibility of colorectal endoscopic submucosal dissection for the treatment of residual or recurrent tumor localized in therapeutic scar tissue. Endosc Int Open 2017; 5: E1242-E1250