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. 2022 Dec 15;10(12):E1562-E1569.
doi: 10.1055/a-1961-1684. eCollection 2022 Dec.

Longly-attached cap can contribute to en bloc underwater endoscopic mucosal resection of 20-30 mm colorectal intramucosal lesions

Hiroyoshi Iwagami  1 , Takuji Akamatsu  1 , Shinya Ogino  1 , Hiroki Morimura  1 , Masayuki Shimoyama  1 , Tomoko Terashita  1 , Shogo Nakano  1 , Midori Wakita  1 , Takeya Edagawa  1 , Takafumi Konishi  1 , Yasuki Nakatani  1 , Yukitaka Yamashita  1
Affiliations

Longly-attached cap can contribute to en bloc underwater endoscopic mucosal resection of 20-30 mm colorectal intramucosal lesions

Hiroyoshi Iwagami et al. Endosc Int Open. .

Abstract

Background and study aims Underwater endoscopic mucosal resection (UEMR) is effective for colorectal intramucosal lesions. The aim of this study was to evaluate whether a longly-attached cap in UEMR improves the en bloc resection rate for 20-30 mm lesions. Patients and methods We performed a retrospective study at a tertiary institute. Candidates for the study were systematically retrieved from an endoscopic and pathological database from October 2016 to December 2020. We assessed the procedural outcomes with UEMR for lesions ≥ 20 mm in size and the clinical factors contributing to en bloc resection. Results A total of 52 colorectal lesions that underwent UEMR were included. The median procedure time was 271 (66-1264) seconds. The en bloc resection rate and R0 resection rate were 75 % and 73 %, respectively. Intraprocedural perforation occurred in one (1.9 %) case, but no bleeding occurred. Delayed bleeding occurred in one (1.9%) case, but no delayed perforation occurred. Regarding tumor size, macroscopic type, tumor location, and the presence or absence of a history of abdominal operation, there was no significant difference between the en bloc resection and piecemeal resection groups. The visibility of the whole lesion, a longly-attached cap, and sessile serrated lesions were more frequently observed in the en bloc resection group than in the piecemeal resection group ( P < 0.001, P = 0.01, and P = 0.04, respectively). Multivariate analysis showed that a longly-attached cap was the only independent factor associated with en bloc resection ( P = 0.02). Conclusions A longly-attached cap might contribute to en bloc resection.

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Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1 a
Fig. 1 a
The length of the endoscope cap is sufficient. The distance between the tip of the cap and the tip of the endoscope is 7 mm in this image. b The length of the endoscopic cap is sufficient when the entire circumference of the tip of the cap can be seen in the monitor. c The cap can be recognized even when the intestinal lumen is filled with water. d The ulcer after resection. e The length of the endoscope cap is insufficient. The distance between the tip of the cap and the tip of the endoscope is 3 mm in this image. f The length of the endoscopic cap is insufficient when the entire circumference of the tip of the cap cannot be seen in the monitor. g The cap cannot be recognized when the intestinal lumen is filled with water. h The ulcer after resection.
Fig. 2
Fig. 2
Patient enrollment.
See this image and copyright information in PMC

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