Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions.

Background: We aimed to evaluate the safety and technical success of an easy-to-use technique that applies underwater cap suction pseudopolyp formation to facilitate the resection of flat lesions or those at the appendiceal orifice or ileocecal valve.
Methods: We retrospectively analyzed a register of consecutive cap suction underwater endoscopic mucosal resection (CAP-UEMR) procedures performed at two centers between September 2020 and December 2021. Procedures were performed using a cone-shaped cap, extending 7 mm from the endoscope tip, to suction the lesion while submerged underwater, followed by underwater snare resection. Our primary end point was technical success, defined as macroscopic complete resection.
Results: We treated 83 lesions (median size 20 mm; interquartile range [IQR] 15-30 mm) with CAP-UEMR: 64 depressed or flat lesions (18 previously manipulated, 9 with difficult access), 11 from the appendix, and 8 from the ileocecal valve. Technical success was 100 %. There were seven intraprocedural bleedings and two delayed bleedings, all managed endoscopically. No perforations or other complications occurred. Among the 64 lesions with follow-up colonoscopy, only one recurrence was detected, which was treated endoscopically.
Conclusions: CAP-UEMR was a safe and effective technique for removing nonpolypoid colorectal lesions, including those arising from the appendiceal orifice or ileocecal valve.
Competing Interests: H. Uchima is consultant for Lumendi, collaborates with ERBE Spain, Olympus Iberia, and Izasa, and has received congress registration from Casen-Recordati. M. Pellisé has served on clinical advisory boards for Fujifilm Europe and MiWendo; owns share options in MiWendo; has received speaker fees from Casen Recordati, Norgine Iberia, Fujifilm, Medtronic, and Olympus; and has received research funding from Fujifilm, Casen Recordati, Ziuz, and 3-D Matrix. A. Calm, R. Muñoz-González, N. Caballero, M. Rosinach, I. Marín, J. Colán-Hernández, I. Iborra, E. Castillo-Regalado, R. Temiño, A. Mata, R. Turró, J. Espinós, and V. Moreno De Vega declare that they have no conflict of interest.
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