Endoscopic cap-assisted mucosal resection of intradiverticular polyp

Lorenzo Del Nero; Massimo Conio

doi:10.5946/ce.2024.342

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Video of Issue Endoscopic cap-assisted mucosal resection of intradiverticular polyp: Lorenzo Del Nero, Massimo Conio; DOI: https://doi.org/10.5946/ce.2024.342
Published online: April 10, 2025

Gastroenterology Department, Santa Corona Hospital, Pietra Ligure, Italy

Correspondence: Lorenzo Del Nero Gastroenterology Department, Santa Corona Hospital, Viale 25 Aprile, 38, 17027 Pietra Ligure (SV), Italy E-mail: Lorenzo.delnero1@gmail.com

• Received: December 12, 2024 • Revised: February 7, 2025 • Accepted: February 13, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Endoscopic resection of polyps located inside a diverticulum may be challenging.¹

There are a few documented cases of intradiverticular polyp removal using a full-thickness resection device² or band ligation-assisted endoscopic mucosal resection.

Endoscopic submucosal dissection for lesions near a colonic diverticulum (D-ESD) has also proven to be a safe and effective technique. However, D-ESD is recommended only in high-volume centers and in experienced hands.³

Another approach is the endoscopic cap-assisted mucosal resection (EMR-C). Distal cap attachment is a useful tool for exposing the intradiverticular mucosa. This is crucial because adequate exposure of the intradiverticular mucosa is mandatory for successful polyp excision.

We report the case of a 65-year-old man who underwent a colonoscopy for altered bowel habits and previous episodes of acute diverticulitis. Colonoscopy revealed distal sigmoid substenosis, which was deemed valuable, and the presence of a granular homogeneous lateral spreading tumor (LST-G) within a sigmoid diverticulum.

Our video shows the removal of an LST-G located in the sigmoid diverticulum using the EMR-C technique (Video 1) (Figs. 1 –3). Prior to the examination, a plastic cap for mucosectomy (MH-597; Olympus Optical Co., Ltd.) with an outer diameter of 17 mm and length of 15 mm was preloaded on the tip of the colonoscope.

Piecemeal polyp resection was performed without severe adverse events. The mild bleeding was managed using diathermic forceps. Histological examination revealed tubulovillous adenoma with low-grade dysplasia.

Endoscopic inspection at three months demonstrated no signs of residual adenomatous tissue.

Although several methods of resection of intradiverticular polyps have been demonstrated, this video shows how the use of a distal cap allows successful exposure of the intradiverticular mucosa and resection with EMR-C. We declare that informed consent was obtained from the patient for the publication of his information and images.

Supplementary Material

Video 1.

Cap-assisted endoscopic mucosal resection of intradiverticular polyps. The use of the cap allows exposure of the intradiverticular mucosa and subsequent radical endoscopic piecemeal excision. Mild intraprocedural bleeding occurred and was managed using diathermic forceps. Three clips were inserted at the end of the procedure.

A video related to this article can be found online at https://doi.org/ce.2024.342.

Conflicts of Interest

The authors have no potential conflicts of interest.

Funding

None.

Author Contributions

Conceptualization: all authors; Data curation: all authors; Writing–original draft: all authors; Writing–review & editing: all authors.

Fig. 1.

Endoscopic cap-assisted view of intradiverticular polyp.

Fig. 2.

Exposition of the intradiverticular tissue.

Fig. 3.

Complete polyp resection.

REFERENCES

1. Tursi A, Scarpignato C, Strate LL, et al. Colonic diverticular disease. Nat Rev Dis Primers 2020;6:20.Article PubMed
2. Zimmer V, Eltze E. A challenging colorectal lesion: truly intradiverticular granular-type laterally spreading tumor. Gastrointest Endosc 2021;93:1187–1189.Article PubMed PMC
3. Ikezawa N, Toyonaga T, Tanaka S, et al. Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum. Clin Endosc 2022;55:417–425.Article PubMed PMC PDF

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