Murone Julie N, Rodgers Brandon, Moyer Matthew T
Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
VideoGIE. 2025 Apr 21;10(9):499-503. doi: 10.1016/j.vgie.2025.04.008. eCollection 2025 Sep.
Colon polyps associated with long-standing inflammation from inflammatory bowel disease (IBD) are prone to develop submucosal fibrosis. This underlying fibrosis from chronic inflammation can make dysplastic mass lesions difficult to resect. Using a distal cap attachment when performing EMR for removal of these fibrotic and scarred-down lesions can be advantageous.
Three representative cases of dysplastic, IBD-associated, colon mass lesions resected by cap-assisted EMR were selected from a previously reported case series for demonstration purposes. Lesions are first evaluated for malignant features, and if none are present, lifting is attempted but often fails to lift the lesion. The cold or hot snare is placed over the lesion, and suction is used to bring the target tissue through the snare and into the clear distal cap attachment. The snare is blindly closed, suction released, and the amount of tissue captured is evaluated. If appropriate, the snare is slightly lifted away from the wall to limit the amount of thermal exposure to the muscularis propria and then subsequently transects the tissue. This process is completed until the lesion is completely removed. Thermal treatment is performed to the lesion edges and any nodularity.
Three cases are presented demonstrating cap-assisted EMR for adherent dysplastic lesions in patients with IBD, with a fourth case included as an example of a type IV muscle injury occurring and treated during cap-assisted EMR.
Distal cap-assisted EMR is a safe and effective technique that can be used in patients with IBD with tacked-down, fibrotic, dysplastic lesions attributable to submucosal fibrosis. However, it is important for endoscopists to be comfortable with lesion recognition as well as recognizing and managing related muscle injuries with a low-threshold for closure of the resection site.
炎症性肠病（IBD）相关的长期炎症所伴发的结肠息肉易于发生黏膜下纤维化。这种慢性炎症导致的潜在纤维化会使发育异常的肿块性病变难以切除。在对这些纤维化且瘢痕化的病变进行内镜黏膜切除术（EMR）时使用远端帽附件可能具有优势。
从先前报道的病例系列中选取3例通过帽辅助EMR切除的IBD相关发育异常结肠肿块性病变的代表性病例用于演示。首先对病变进行恶性特征评估，若不存在恶性特征，则尝试提起病变，但通常无法提起。将冷圈套器或热圈套器置于病变上方，利用吸引使目标组织穿过圈套器进入透明的远端帽附件。盲目闭合圈套器，释放吸引，评估捕获的组织量。若合适，将圈套器从肠壁略微提起以限制对固有肌层的热暴露量，随后切断组织。重复此过程直至病变完全切除。对病变边缘及任何结节进行热处理。
展示了3例IBD患者中使用帽辅助EMR切除粘连性发育异常病变的病例，还纳入了第4例作为帽辅助EMR过程中发生并处理的IV型肌肉损伤的示例。
远端帽辅助EMR是一种安全有效的技术，可用于患有因黏膜下纤维化导致的固定、纤维化、发育异常病变的IBD患者。然而，内镜医师熟悉病变识别以及识别和处理相关肌肉损伤并对切除部位闭合保持低阈值至关重要。
