EMR of upper GI lesions when using a novel soft, irrigation, prelooped hood

Abstract

Background: EMR with a cap-fitted endoscope, including a soft, prelooped hood, is a useful, effective, and safe technique. One problem with this method, however, is that the lesion cannot always be kept in the center of the cap because the procedure is performed blindly after aspiration. A soft, prelooped hood with attached irrigation tube was developed. The usefulness of this device for EMR of upper-GI intramucosal cancers was evaluated.

Methods: The end-hood piece was fabricated by drilling a side hole in the cap portion of a conventional soft, prelooped hood and then attaching an irrigation tube with glue to the exterior surface of the hole. The fabricated transparent hood was placed at the tip of an endoscope, and aspiration mucosectomy under irrigation was performed in 15 patients with upper-GI intramucosal cancer. When the field of view at the aspiration site was obscured by oozing blood, the site was irrigated.

Results: A satisfactory view was obtained of all lesions. The mean diameter of specimens was 24.5 mm (interquartile range: 15-35). The proportion of en bloc resected lesions was 86.7% (13/15). Bleeding was the only complication (4/15; 26.7%) and was controlled by using endoscopic hemostatic techniques under irrigation.

Conclusions: EMR when using the soft, prelooped hood with irrigation tube is effective and safe for intramucosal cancers 20 mm or less in diameter.