Cap-assisted snare capture technique for resection of fibrotic large polyps

Abstract

Background and AimsEndoscopic mucosal resection (EMR) of non-lifting or fibrotic polyps may pose challenges, especially when the snare fails to capture flat or depressed fibrotic areas. We present “cap-assisted snare capture” technique using the distal attachment clear cap as an adjunct to EMR for the resection of residual fibrotic tissue. MethodsThree consecutive patients referred for EMR of colonic laterally spreading tumors were included in this case series. Prior to EMR referral, biopsy or attempt for resection of these lesions was not performed. The fibrotic residual tissue after EMR was resected using distal attachment clear cap at tip of adult colonoscope, by placing a soft braided hot snare around the fibrotic tissue and suctioning of tissue into the distal attachment cap while simultaneously closing snare. The suction was released and snare capture of targeted tissue was confirmed prior to snare resection of tissue. The resected site was evaluated for perforation and bleeding prior to closure with clips. ResultsThree presented cases demonstrate the effectiveness of the “cap-assisted snare capture” technique in resecting residual fibrotic tissue and highlights the safety and efficacy of this technique in challenging EMR scenarios (video). There was no perforation, significant bleeding or major adverse events. Conclusions“Cap-assisted snare capture” is a simple technique to assist with resecting fibrotic adenomatous tissue that cannot be captured with conventional snare closure. Its simplicity, use of standard equipment, and effectiveness makes it a valuable adjunct technique in difficult EMR procedures. Larger cohort studies are needed to validate the safety and efficacy of this technique.