Short cap technique to complete EMR of very flat colorectal laterally spreading tumors

Parsa_headshotParsa_Rex_headshotPost written by Nasim Parsa, MD, and Douglas K. Rex, MD, FASGE, from John Hopkins Hospital, Baltimore, Maryland, and Indiana University School of Medicine, Indianapolis, Indiana.

In this video, we demonstrate the utility of a short cap placed over the colonoscope tip to facilitate endoscopic mucosal resection (EMR) of very flat portions of lateral spreading tumors (LSTs).

After submucosal injection, a small flexible snare (10-11 mm) is placed over the very flat tissue. The colonoscope tip then approaches the tissue very closely. Suction is then applied to pull the flat lesion through the open snare so that it enters the cap. With the colonoscope image blinded by the suctioned tissue, the technician closes the snare and reports verbally when the tissue is grasped. Suction is then released so that the snared tissue is visualized before transection.

Snare resection, the preferred technique for the removal of very flat portions of LSTs, can often be frustrating as even a stiff snare may slide over the very flat lesion. Hot forceps avulsion and the short cap technique, which we demonstrate in this video, are the 2 available options. The short cap technique is more efficient, as a larger surface area of the flat lesion can be removed in a single action.

In regular practice, the endoscopist may encounter difficulties while snaring a flat, partially flat, or non- granular LST during EMR. If so, this technique should be considered for EMR of these lesions.

The short projection of the cap from the colonoscope tip makes this technique very safe throughout the colon and rectum. The projection does not have enough depth to pull the muscularis propria into the cap. We have used this technique for hundreds of EMRs without a single perforation or muscle injury associated with this technique.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.


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