Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps

Abstract

Background Suboptimal lifting increases complexity of endoscopic mucosal resection (EMR) for benign colorectal polyps. Cap-assisted EMR (EMR-C) may allow fibrotic polyp tissue to be captured in the snare. This study evaluated the efficacy and safety of EMR-C for benign nonlifting colorectal polyps. Methods This was a multicenter study, which prospectively registered all EMR-C procedures (2016–2018) for presumed benign nonlifting colorectal polyps. Results 70 nonlifting polyps with a median size of 25 mm (interquartile range [IQR] 15–40) were treated with EMR-C. Complete polyp removal was achieved in 68 (97.1 %), including 47 (67.1 %) with EMR-C alone. Overall, 66 polyps showed benign histology, and endoscopic follow-up after a median of 6 months (IQR 6–10) showed recurrence in 19.7 %. First (n = 10) and second (n = 2) benign recurrences were all treated endoscopically. Deep mural injury type III–V occurred in 7.4 % and was treated successfully with clips. Conclusion EMR-C may be an alternative therapeutic option for removal of benign nonlifting polyp tissue. Although recurrence still occurs, repeat endoscopic therapy usually leads to complete polyp clearance.

Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024

“…Hot or cold avulsion of residual neoplasia > 15 mm is time-consuming and technically challenging, although such extensive areas of residual neoplasia should be very infrequent with high quality EMR practice. A recent paper showed that suction of the target area into the cap through a 10-mm snare may be successful in grasping larger target areas and thereby limiting the number of large nonlifting areas [95]; however, perforation was encountered, although this could be treated with endoscopic clip closure in all cases.…”

Distal Cap-Assisted Endoscopic Mucosal Resection (EMR-DC) For Non-lifting Colorectal Polyps – Are We Doing It Right?

“…In this issue of Endoscopy, Van der Voort et al reported the utility and safety of distal cap-assisted EMR (EMR-DC) to treat fibrotic colorectal polyps [5]. Their main objective was to determine the recurrent adenoma rate at first follow-up (6-10 months), and the secondary objective was technical success and safety.…”

Cap-EMR Ⅱ

“… 2 Recently, EMRC has gained widespread recognition as a safe and effective treatment for the esophagus, stomach, duodenum, and colon. 3 , 4 , 5 , 6 EMRC can be used throughout the entire digestive tract. Additionally, it is used in anti-reflux mucosectomy 7 , 8 and anti-reflux mucoplasty (ARM-P), 9 , 10 both of which serve as endoscopic treatments for patients with proton pump inhibitor refractory–dependent GERD.…”