Cap-Assisted EMR Produced Faster Resection Times and Lower Recurrence Rates Compared to Traditional EMR
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Cap-Assisted EMR Produced Faster Resection Times and Lower Recurrence Rates Compared to Traditional EMR

Douglas K. Rex, MD, MASGE, reviewing Conio M, et al. Gastrointest Endosc 2022 Jun 10.

Cap-assisted EMR (EMR-C) involves submucosal injection followed by resection using a stiff Olympus cap (MH-597, Olympus Optical Co, Ltd, Tokyo, Japan) with an outer diameter of 17 mm and length of 15 mm and a snare prepositioned in a groove at the end of the cap. 

In a randomized trial from 4 centers in Italy, 138 patients underwent EMR-C and 102 received standard EMR (EMR-S). The median lesion size was 30 mm in the EMR-C group versus 35 mm in the EMR-S group. The median procedure time was shorter for EMR-C at 20 minutes versus 30 minutes for EMR-S. Despite this, the number of resected pieces was greater for EMR-C (n=9) than EMR-S (n=4), and the median number of polypectomy snares used to perform EMR was 5 with EMR-C and 1 with EMR-S. EMR-C required less injection fluid at 15 ml versus 35 ml with EMR-S. Argon plasma coagulation (APC) was used to destroy small remnants of polyp in 2.9% of EMR-C cases versus 22.5% of EMR-S cases. There were 2 perforations in the EMR-C group and 1 in the EMR-S group.

For unclear reasons, granular laterally spreading tumors were more common with EMR-S (70.6%) than EMR-C (47.6%). The rates of residual lesions at follow-up were 5.8% in the EMR-C group and 31.4% in the EMR-S group (P<.001).

Douglas K. Rex, MD, FASGE

COMMENT

These data appear to favor EMR-C. However, it is important to remember that these investigators are the world’s experts in this technique. Further, the results in the EMR-S arm were suboptimal, partly because APC was used to treat residual visible polyp (this should no longer be used because it increases recurrence rates), and snare tip soft coagulation was not used to treat the normal-appearing margin. Novices should understand that caution is necessary for using this device and that suctioning tissue too far into the cap increases the risk of perforation.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Conio M, Manta R, Filiberti RA, et al. Cap-assisted endoscopic mucosal resection versus standard inject and cut endoscopic mucosal resection for large colonic laterally spreading tumors treatment: a randomized multicenter study (with video). Gastrointest Endosc 2022 Jun 10. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.06.002)

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