ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | November 2022-10 Yang_Hybrid EMR Bringing ESD tricks to standard EMR

10 Yang_Hybrid EMR Bringing ESD tricks to standard EMR

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In this article, Dr. Dennis Yang discusses the use of Hybrid Endoscopic Mucosal Resection (EMR) in standard EMR procedures. EMR is the first-line treatment for non-malignant colorectal lesions, with a high rate of technical success and lower morbidity/mortality compared to surgery. However, EMR has limitations when it comes to en-bloc resection of larger lesions and in cases with submucosal fibrosis.<br /><br />Dr. Yang explains that Endoscopic Submucosal Dissection (ESD) can be used for en-bloc resection, providing accurate histopathology and curative treatment for early cancer. However, ESD has a steep learning curve and higher rates of adverse events, making it a less accessible option for all cases.<br /><br />Therefore, Dr. Yang suggests alternatives such as Pre-cut EMR and Hybrid ESD. Pre-cut EMR involves a circumferential mucosal incision followed by snare resection, which is ideal for en-bloc resection of lesions up to 20-30 mm in size. Hybrid ESD combines a mucosal incision with submucosal dissection and snare resection, allowing for larger lesions to be resected.<br /><br />Dr. Yang emphasizes the importance of proper technique and shares tips for successful mucosal incision and submucosal dissection. He also discusses the ongoing research comparing hybrid ESD to non-hybrid ESD, which aims to evaluate procedural time, resection outcomes, adverse events, and recurrence.<br /><br />Overall, Dr. Yang concludes that Pre-cut EMR and Hybrid ESD can increase the en-bloc resection rate in difficult cases and provide a stepwise approach towards learning conventional ESD. These techniques are especially useful for fibrotic lesions and cases requiring en-bloc resection of invasive cancer.

Keywords

Hybrid Endoscopic Mucosal Resection

EMR

colorectal lesions

en-bloc resection

submucosal fibrosis

Endoscopic Submucosal Dissection

Pre-cut EMR

Hybrid ESD

mucosal incision

snare resection