Endoscopic Mucosal Resection Cap Assisted EMRC

A transparent, hard plastic cap is preloaded on the tip of a standard front viewing endoscope. The appropriate size and diameter of the cap is selected according to the location where the EMR will be performed. Inside the distal end of the cap is a gutter, which positions the opened polypectomy snare. Removal of a 3 mm segment of the gutter with a blade scalpel before placement on the endoscope tip is recommended. This modification is then aligned with the operative channel of the endoscope to avoid interference with the injection needle or other devices with the gutter. After creation of the submucosal fluid cushion, the cap is applied against the lesion, which is aspirated into it. The opened snare is then firmly secured around the tissue and resection is performed. A monofilament polypectomy snare is used. It should be applied with caution in the gastric fundus, duodenum, and ascending colon. The limited thickness of the muscularis propria can result in its entrapment, leading to a perforation. Injection of a large amount of a submucosal solution is recommended.

A soft cap has been tested to remove large diameter gastric lesions. This cap is deformable and can be introduced into the esophagus. The diameter of the soft cap is 18 mm, whereas the diameter of the hard one is 16.5 mm. The diameter, the depth of the resected specimen, and the rate of "en bloc" resection were compared between the two. With the soft cap the diameter was larger (22.1 mm vs 15.8 mm), deeper (1.54 mm vs 1.08 mm), and the rate of "en bloc" resection was higher (66.7% vs 43.2%) (Matsuzaki et al, 2003).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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