Commentary

Several randomized controlled trials have demonstrated the superiority of underwater endoscopic mucosal resection (UEMR) over conventional EMR. The cap-suction method presented by Benites-Goni et al. further expands the possibilities of UEMR. The target lesion is repeatedly suctioned into a slim hood, resulting in a pseudopolypous stalk, making en bloc resection of even large and flat lesions possible. However, the boundaries of new innovative techniques become more obvious with experience. Suction-induced mucosal bleeding may impair underwater visibility, but in addition, when the lesion is located on the top of a semilunar fold suction-based pseudopolyp formation may include the muscle layer, leading to inadvertent perforation. Nevertheless, for lesions suspicious for submucosal invasive cancer, en bloc resection is paramount, and UEMR based on cap suction may become a vital addition to the endoscopic toolbox.

Publication History

Article published online:
28 May 2025