ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | November 2022-Deep Dive on Underwater EMR

Video Transcription

Video Summary

In this video, a speaker discusses the technique of underwater endoscopic mucosal resection (EMR) as a treatment option for colonic laterally spreading tumors (LSTs). The speaker begins by stating that underwater EMR is a mature procedure that is ready to be taught to fellows and used more widely. They credit Dr. Ben Moeller for describing the technique in 2012 and Dr. Christopher Hamersky for his mentorship.<br /><br />The speaker explains that conventional EMR involves injecting a solution into the submucosal space to create a safety cushion, but this can make snare capture of a flat polyp more difficult and may enlarge the lesion. Underwater EMR, on the other hand, fills the lumen with water, eliminating the need for submucosal injection and allowing for better mucosal and submucosal capture, resulting in higher on-block resection rates.<br /><br />The speaker discusses the data on underwater EMR, including a prospective observational study in 2012 and a multicenter randomized control trial that compared underwater and conventional EMR. The results showed that underwater EMR had shorter resection and procedure times, higher on-block resection rates, and fewer additional techniques required for complete resection. Adverse events were similar between the two groups.<br /><br />The speaker also provides tips on how to perform underwater EMR, such as paying attention to lesion morphology, examining for tattoo markings, and using a technique called "pushing the catheter to meet the closure" to ensure proper snare capture. They demonstrate the technique through video examples.<br /><br />The speaker concludes by stating that underwater EMR is a first-line option for colonic LSTs, with the benefits of faster resection, higher on-block resection rates, and lower recurrence rates. They note that while there may be some limitations and risks, underwater EMR is safe and effective when performed correctly.<br /><br />Note: This summary is based on the transcript of the video and does not include any additional information presented visually.

Asset Subtitle

Jason B. Samarsena, MD

Keywords

underwater endoscopic mucosal resection

colonic laterally spreading tumors

Dr. Ben Moeller

Dr. Christopher Hamersky

conventional EMR

prospective observational study

multicenter randomized control trial