ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy (On-Demand) | October 2022-Practice Updates: EMR Techniques: How to Choose the Optimal One

Video Transcription

Video Summary

In this video presentation, Dr. Douglas K. Rex discusses EMR (Endoscopic Mucosal Resection) techniques for colorectal lesions. He begins by addressing the challenges faced when dealing with fibrotic tissue, including size and shape of lesions. Dr. Rex introduces the "CAP technique", which involves using a short cap attachment at the end of the scope to suction fibrotic tissue into a snare for resection. He also discusses the "avulsion technique", which entails pulling off tissue with forceps. Dr. Rex emphasizes the use of water for improved access and on-block resection rates, particularly for pedunculated lesions and non-granular flat elevated lesions. He advises against ablating visible polyp tissue and instead recommends snaring or avulsing it. The presentation also covers the benefits of cold resection for polyposis syndromes and massive homogeneous granular lateral spreading tumors. Dr. Rex highlights the importance of using appropriate snare sizes and electrocautery currents. He touches on other topics such as cauterizing blood vessels, techniques for suturing, and the significance of NICE-3 or KUDO-5 lesions. Overall, Dr. Rex provides practical insights and recommendations for optimal EMR techniques in various clinical scenarios.

Asset Subtitle

Douglas K. Rex, MD, MASGE, MACG

Keywords

EMR

Endoscopic Mucosal Resection

colorectal lesions

fibrotic tissue

CAP technique

avulsion technique