ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Onboarding (Day One) | March 2025-Considerations for EMR and ESD

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The document by Dr. Vivek Kaul outlines important considerations for Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), both key techniques for treating superficial neoplasia in the gastrointestinal tract, including early-stage cancers and precancerous lesions in areas such as the esophagus, stomach, duodenum, colon, and rectum.<br /><br />EMR is generally used for lesions limited to the mucosa, like early cancers and dysplastic lesions, and uses techniques like submucosal injection and resection. ESD, on the other hand, is suitable for larger lesions often with anticipated submucosal fibrosis, allowing for the removal of complex lesions in one piece but requiring more expertise and carrying a higher risk of complications like perforation.<br /><br />Key considerations for Advanced Practice Providers (APPs) include patient selection, education, preparation processes, and managing potential complications collaboratively with endoscopists. Follow-up care is critical, especially considering the risk of complications such as bleeding, which is a common issue for both EMR and ESD. Additionally, thorough pre-procedure assessments, including anesthesia and medication management, are essential.<br /><br />The document highlights the effectiveness and safety of EMR and ESD, noting that while ESD allows for higher rates of complete and curative resections and lower recurrence rates, it carries a higher risk of adverse events like perforation compared to EMR. A multidisciplinary approach is often needed for invasive cancers or incomplete resections, with an emphasis on personalized surveillance strategies based on individual patient and lesion characteristics.<br /><br />In practice, APPs play a vital role in managing the pre-procedure and follow-up phases, including optimization of patient conditions, medication adjustments, and interdisciplinary care coordination, ensuring comprehensive management and enhancing patient outcomes in endoscopic procedures.

Asset Subtitle

Vivek Kaul, MD, FASGE

Keywords

Endoscopic Mucosal Resection

Endoscopic Submucosal Dissection

gastrointestinal tract

superficial neoplasia

early-stage cancers

patient selection

complications management

Advanced Practice Providers

multidisciplinary approach

personalized surveillance