ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (On-demand) | May 2023-Keswani_ Does the Data Determine Which Resection Method to Use 2023

Keswani_ Does the Data Determine Which Resection Method to Use 2023

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The document discusses different endoscopic resection (ER) techniques for treating malignant colorectal polyps. It highlights the importance of considering the location and features of the polyp, as well as the individual expertise of the endoscopist when choosing the appropriate method. The document also provides data on the risk of occult malignancy in patients referred for endoscopic resection.<br /><br />Several potential questions comparing different ER techniques are listed, including EMR versus cold EMR, EMR versus underwater EMR (uEMR), EMR versus hybrid ESD, EMR versus full thickness resection (FTR), and more. The document emphasizes that ER is known to be more cost-effective and safer than surgery.<br /><br />The evidence comparing various ER techniques is summarized. EMR is recommended for nearly all colon polyps and select rectal polyps, with caveats such as margin ablation. ESD (endoscopic submucosal dissection) is preferred for cases with suspected invasive malignancy or when EMR is not suitable. The document mentions that ESD complications can vary depending on experience, but nearly all recurrences can be managed endoscopically.<br /><br />Data on cold EMR versus conventional EMR is mentioned, with randomized data still to come. Cold EMR has shown promising results for serrated lesions and adenomatous lesions. Underwater EMR has similar bleeding and perforation rates to conventional EMR. Hybrid ESD, which involves circumferential incision and possible dissection, has shown favorable outcomes compared to EMR in terms of R0 resection, en bloc resection, and resection time.<br /><br />The document concludes with recommendations for selecting the appropriate ER technique based on the characteristics of the polyp. For colon polyps with suspect invasive malignancy, surgery or ESD may be considered. For polyps with no suspicious features, EMR is recommended. The document also provides recommendations for rectal polyps based on their features.<br /><br />Overall, the document provides an overview of the evidence comparing different ER techniques for treating malignant colorectal polyps and offers recommendations for selecting the appropriate method based on polyp characteristics.

Keywords

endoscopic resection

malignant colorectal polyps

ER techniques

polyp location

polyp features

occult malignancy risk

EMR versus cold EMR

EMR versus underwater EMR

hybrid ESD outcomes

selecting appropriate ER technique