Endoscopic Mucosal Resection: Best Practices for Gastrointestinal Endoscopists

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Endoscopic mucosal resection (EMR) is a key technique for gastrointestinal lesion removal.
• Large colorectal polyps are the primary indication for EMR, necessitating specialized evaluation.

Purpose of the Study:

• To review endoscopic mucosal resection (EMR) techniques for large colorectal polyps.
• To discuss polyp evaluation, EMR methods, adverse events, and post-procedure surveillance.

Main Methods:

• Review of conventional hot-snare EMR with submucosal injection.
• Exploration of alternative EMR techniques: cold-snare and underwater EMR.
• Discussion of polyp evaluation methods for EMR feasibility.

Main Results:

• EMR is feasible for sessile or flat gastrointestinal lesions, particularly large colorectal polyps.
• Key adverse events include bleeding, perforation, and post-polypectomy coagulation syndrome.
• Surveillance is essential due to the possibility of residual or recurrent polyps.

Conclusions:

• EMR is a valuable endoscopic technique for large colorectal polyps.
• Appropriate patient selection and post-EMR surveillance are critical for optimal outcomes.
• Understanding EMR techniques and risks minimizes complications and ensures effective polyp management.