用帽辅助EMR去除炎症性肠病相关的良性负举征的发育不良病变：为执业胃肠病学家准备的视频教程

Q3 Medicine

VideoGIE Pub Date : 2025-04-21 DOI:10.1016/j.vgie.2025.04.008

Julie N. Murone DO, Brandon Rodgers MD, Matthew T. Moyer MD, FASGE

{"title":"用帽辅助EMR去除炎症性肠病相关的良性负举征的发育不良病变：为执业胃肠病学家准备的视频教程","authors":"Julie N. Murone DO, Brandon Rodgers MD, Matthew T. Moyer MD, FASGE","doi":"10.1016/j.vgie.2025.04.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 9","pages":"Pages 499-503"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Removing inflammatory bowel disease–associated dysplastic lesions with benign negative lift sign with cap-assisted EMR: a video tutorial for practicing gastroenterologists\",\"authors\":\"Julie N. Murone DO, Brandon Rodgers MD, Matthew T. Moyer MD, FASGE\",\"doi\":\"10.1016/j.vgie.2025.04.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":55855,\"journal\":{\"name\":\"VideoGIE\",\"volume\":\"10 9\",\"pages\":\"Pages 499-503\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"VideoGIE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2468448125001109\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"VideoGIE","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468448125001109","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

背景和目的与炎症性肠病（IBD）长期炎症相关的结肠息肉容易发展为粘膜下纤维化。慢性炎症引起的纤维化使发育不良肿块难以切除。当进行EMR切除这些纤维化和瘢痕病变时，使用远端帽连接是有利的。方法从先前报道的病例系列中选择3例典型的发育不良，ibd相关的结肠肿块病变，通过帽辅助EMR切除，以进行演示。首先评估病变是否有恶性特征，如果没有，则尝试解除，但通常无法解除病变。将冷诱捕器或热诱捕器放置在病变部位上，并使用吸力将目标组织通过诱捕器并进入清晰的远端帽附件。陷阱盲目关闭，释放吸力，并评估捕获的组织量。如果合适，将诱捕器从壁上略微抬起，以限制固有肌层的热暴露量，然后横切组织。这个过程一直持续到病变被完全切除。对病变边缘和任何结节进行热处理。结果：三个病例展示了cap辅助EMR对IBD患者粘附性发育不良病变的治疗，第四个病例作为IV型肌肉损伤的例子，在cap辅助EMR期间发生和治疗。结论远端帽辅助EMR是一种安全有效的技术，可用于IBD伴粘膜下纤维化、纤维化和发育不良病变患者。然而，对于内窥镜医师来说，熟悉病变识别以及识别和处理相关肌肉损伤是很重要的，因为切除部位的关闭阈值较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Removing inflammatory bowel disease–associated dysplastic lesions with benign negative lift sign with cap-assisted EMR: a video tutorial for practicing gastroenterologists

Background and Aims

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.

Methods

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.

Results

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.

Conclusions

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.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.