Dissection-enabled scaffold-assisted resection (DeSCAR): a novel technique for resection of residual or non-lifting GI neoplasia of the colon (with video).

Due to previous manipulation or submucosal invasion, GI lesions referred for endoscopic mucosal resection (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.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, prior manipulation, rates of successful hybrid resection, and adverse events.Twenty-nine lesions underwent DeSCAR due to non-lifting or residual "islands" of tissue. Patients were 52% male, 48% female, and average age 66 (SD +/- 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 (SD +/- 20.6 mm). Previous manipulation occurred in 28/29 cases (83% biopsy, 34% resection attempt, 52% tattoo). The technical success rate for resection of non-lifting lesions was 100%. There was one delayed bleeding episode but no other adverse events.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.