Background and Aims

As a result of previous manipulation or submucosal invasion, GI lesions referred for EMR frequently have flat areas of visible tissue that cannot be snared. Current methods for treating residual tissue may lead to incomplete eradication or not allow complete tissue sampling for histologic evaluation. Our aim is to describe dissection-enabled scaffold-assisted resection (DeSCAR), a new technique combining circumferential ESD with EMR for removal of superficial non-lifting or residual “islands” with suspected submucosal involvement/fibrosis.

Methods

From 2015 to 2017, lesions referred for EMR were retrospectively reviewed. Cases were identified where lifting and/or snaring of the lesion was incomplete and the DeSCAR technique was undertaken. Cases were reviewed for location, previous manipulation, rates of successful hybrid resection, and adverse events.

Results

Twenty-nine lesions underwent DeSCAR because of non-lifting or residual “islands” of tissue. Fifty-two percent of the patients were male and 48% were female; average age was 66 years (standard deviation ±9.9 years). Lesions were located in the cecum (n = 10), right side of the colon (n = 12), left side of the colon (n = 4), and rectum (n = 3). Average size was 31 mm (standard deviation ±20.6 mm). Previous manipulation had occurred in 28 of 29 cases (83% biopsy, 34% resection attempt, 52% tattoo). The technical success rate for resection of non-lifting lesions was 100%. There was one episode of delayed bleeding but no other adverse events.

Conclusions

DeSCAR is a feasible and safe alternative to argon plasma coagulation and avulsion for the endoscopic management of non-lifting or residual GI lesions, providing en bloc resection of tissue for histologic review. Further studies are needed to demonstrate long-term eradication and for comparison with other methods.

中文翻译：

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可进行解剖的支架辅助切除术（DeSCAR）：一种用于切除结肠残余或非提升性GI肿瘤的新技术（带视频）

背景和目标

由于先前的操作或粘膜下浸润，转为EMR的GI病变通常具有可见组织的平坦区域，无法被发现。当前用于治疗残留组织的方法可能会导致根除不彻底或不允许对组织进行完整的组织采样以进行组织学评估。我们的目的是描述可解剖的支架辅助切除术（DeSCAR），这是一种结合了周向ESD和EMR的新技术，用于去除表面浅层非隆起或残留的“岛”以及可疑的粘膜下累及/纤维化。

方法

从2015年至2017年，回顾了接受EMR治疗的病变。确定病例，病灶的解除和/或缠结不完全，并进行了DeSCAR技术。检查病例的位置，先前的操作，成功的混合切除率和不良事件。

结果

由于组织不隆起或残留“岛”，因此对29个病变进行了DeSCAR。52％的患者为男性，48％为女性。平均年龄为66岁（标准差为±9.9年）。病变位于盲肠（n = 10），结肠右侧（n = 12），结肠左侧（n = 4）和直肠（n = 3）。平均尺寸为31毫米（标准偏差为±20.6毫米）。29例病例中有28例曾进行过先前的手术（83％的活检，34％的切除尝试，52％的纹身）。切除非隆起性病变的技术成功率为100％。有1例延迟出血，但无其他不良事件。

结论

DeSCAR是氩气血浆凝结和撕脱术的可行且安全的替代方法，可用于内镜处理非抬升性或残留性GI病变，为整体组织切除提供组织学检查。需要进一步的研究来证明长期根除并与其他方法进行比较。