Distal cap-assisted endoscopic mucosal resection safe, effective for fibrotic polyps
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CHARLOTTE, N.C. — Distal cap-assisted endoscopic mucosal resection is safe and effective for managing non-lifting and fibrotic colorectal polyps, according to a multicenter study presented at ACG 2022 Annual Scientific Meeting.
“Multiple interventions have been proposed for management of these polyps; however, each have limitations,” Scott R. Douglas, MD, from Penn State Health Milton S. Hershey Medical Center, and colleagues wrote.
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According to researchers, submucosal fibrosis is a common occurrence and may be caused by biopsy sampling, submucosal tattoo or previous ineffective polyp resection attempts. A developing technique for management of this condition is distal cap-assisted endoscopic mucosal resection (EMR-DC), in which tissue from adherent areas is suctioned through an open snare on a clear distal attachment cap fitted 3 to 4 mm from the colonoscope tip, and the cap is closed on the lesion. Electrocautery was used to transect the tissue.
In this retrospective study, three endoscopists performed EMR-DC in 61 patients (mean age, 66.8 years). The majority of cases (88.5%) had previously attempted polypectomies, followed by previous biopsy (4.9%), biopsy and tattoo (4.9%), and submucosal tattoo injection (1.6%). The average lesion size was 49 mm (range, 15-95 mm).
Researchers reported complete macroscopic resection in 100% of cases, with a low adenoma recurrence rate of 9.8% at 6 months. The procedure took an average 49.5 minutes to perform, and only two serious adverse events occurred: One patient experienced post-polypectomy syndrome and needed hospitalization, and one had a post-procedural bleeding that required repeat colonoscopy.
Douglas and colleagues concluded that EMR-DC is “safe and efficacious” and that it “may offer several advantages over more expensive or invasive endoscopic techniques used for the indication.”
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Douglas SR, et al. Abstract S130: Distal Cap-Assisted Endoscopic Mucosal Resection Is a Safe and Effective Technique for Resection of Non-Lifting or Adherent Colorectal Polyps: An International, Multicenter, Retrospective Study. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
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