ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-10B_Kothari

10B_Kothari_ASGE 2023 EMR colon

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In this comparative analysis of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), Dr. Shivangi T. Kothari emphasizes why EMR is often more advantageous for treating large colon polyps. EMR is highlighted as a safer, quicker, and cost-effective method, effective for large benign polyps, with a higher recurrence rate (0-20%) but acceptable follow-up and retreatment success. In contrast, ESD, though enabling en bloc resections (complete removal in one piece) and having lower recurrence rates, is longer, riskier (higher perforation and bleeding rates), more expensive, and requires extensive training and skill.<br /><br />Key points include:<br />- Polyp assessment requires understanding type, size, and location to determine the appropriate intervention.<br />- For large polyps, EMR is preferred due to its efficiency and lower complication rates.<br />- Safe execution of hot snare polypectomy (a core technique in EMR) necessitates informed consent, proper preparation, and specific technical steps to minimize complications such as fibrosis.<br />- Submucosal injection and careful inspection of the polyp’s mobility and firmness are crucial for effective resection.<br />- Surveillance post-EMR is important, with guidelines suggesting follow-ups, especially after piecemeal resections, to monitor and treat any residual adenoma.<br /><br />While ESD may be beneficial for cases predicted to have cancer or significant submucosal fibrosis, its adoption is limited by higher technical demands and associated risks.<br /><br />Dr. Kothari concludes that EMR is generally the practical choice for benign colon polyps due to its demonstrated efficacy, safety, and cost-effectiveness, while ESD is reserved for specific complex cases. The decision to use either technique should be informed by a thoughtful assessment rather than the mere capability to perform the procedure. The overall recommendation underscores the importance of balancing effectiveness, safety, and practicality in endoscopic polyp treatments.

Keywords

Endoscopic Mucosal Resection

Endoscopic Submucosal Dissection

large colon polyps

Dr. Shivangi T. Kothari

EMR advantages

ESD risks

hot snare polypectomy

polyp assessment

submucosal injection

surveillance post-EMR