ASGE Masterclass: Expert Performance Approach to Colonoscopy (On-Demand) | February 2026-Dynamic Injection and Mucosal Resection

Video Transcription

Video Summary

The speaker reviews key considerations and technique refinements for conventional endoscopic mucosal resection (EMR) of larger colorectal lesions. Appropriate patient selection is essential: lesions with deep submucosal invasion or a “non-lifting sign” should not undergo EMR. Adequate bowel preparation and readiness for urgent defect closure with clips are emphasized to reduce perforation and colostomy risk. Cap use helps flatten folds, improve visualization, and facilitate precise clip placement; extending cap length can improve targeting.<br /><br />The main technical focus is “dynamic” submucosal injection versus static injection. Dynamic injection sculpts a large, concentrated submucosal cushion by rapid injection while moving the needle, applying endoscopic torque, lifting the scope tip, and often suctioning/deflating the lumen. This elevates lesions to enable safer en bloc or piecemeal snare resection while avoiding injury to deeper submucosal vessels near the muscularis propria.<br /><br />A second safety step is the “open-close” snare maneuver: briefly opening the snare while looking up to free deep tissue, then re-closing before cautery to reduce muscular capture and perforation risk. Edge coagulation (APC or snare-tip) is discussed to reduce recurrence, but not when visible residual lesion remains. Pathologic cure criteria and EMR limitations (fibrosis, certain high-risk lesion types) are outlined.

Asset Subtitle

Roy Soetikno

Keywords

endoscopic mucosal resection (EMR)

large colorectal lesions

dynamic submucosal injection

non-lifting sign

open-close snare maneuver

defect closure with clips