ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day One)

Video Transcription

Video Summary

The transcript outlines endoscopic resection as a major “third pillar” of modern endoscopy alongside ERCP/EUS and bariatric/metabolic endoscopy. It focuses on team-based care for two key techniques: endoscopic mucosal resection (EMR), which removes superficial mucosa often piecemeal, and endoscopic submucosal dissection (ESD), which enables en bloc removal of larger or potentially cancerous lesions by dissecting in the submucosa using specialized knives. EMR is generally quicker and safer with lower perforation/bleeding risk, but has higher recurrence due to piecemeal resection; ESD offers higher en bloc/curative resection and lower recurrence but is longer, more technically demanding, and has higher complication rates, especially early in an operator’s experience. The speaker emphasizes proper patient selection, detailed pre-procedure optimization (prep quality, meds like GLP-1s, coagulopathy, airway, anatomy), informed consent including surgical alternatives, and vigilant post-procedure monitoring. Pathology review drives next steps, with high-risk features (poor differentiation, lymphovascular invasion, submucosal invasion, positive margins) prompting tumor board discussion and surgical/oncology referral. Bleeding is the most common complication.

Asset Subtitle

Vivek Kaul, MD, FASGE

Keywords

endoscopic resection

endoscopic mucosal resection (EMR)

endoscopic submucosal dissection (ESD)

en bloc resection vs piecemeal resection

post-procedure bleeding complication

pathology high-risk features and surgical referral