Distal cap–assisted EMR allows the safe and effective resection of adherent dysplastic lesions in the setting of inflammatory bowel disease: a multicenter retrospective study (with video)

Background and Aims: EMR is established as the primary approach for large and complex dysplastic lesions. However, submucosal fibrosis caused by previous attempts at removal, biopsy sampling, inflammation, or tattoo placement can cause a benign “negative lift sign” and create difficulty for EMR. Here, we present the use of distal cap–assisted EMR (EMR-DC) specifically for the use of resecting dysplastic colonic lesions when submucosal fibrosis is present in patients with inflammatory bowel disease (IBD). Methods: Sixteen IBD patients were retrospectively evaluated from 2 high-volume centers. Patient demographics, lesion pathology and classification, outcomes including time and success of resection, serious adverse events (SAEs) within 30 days of the procedure, and efficacy were measured. Results: Seventy-five percent of patients treated with EMR-DC achieved complete resection with no SAEs within 30 days of the procedure. Conclusions: EMR-DC represents an attractive option for the resection of adherent, dysplastic lesions in chronic IBD that is effective, safe, and inexpensive.