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)

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). 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. Seventy-five percent of patients treated with EMR-DC achieved complete resection with no SAEs within 30 days of the procedure. EMR-DC represents an attractive option for the resection of adherent, dysplastic lesions in chronic IBD that is effective, safe, and inexpensive.