Masterclass Colonoscopy: Trends and Recommendations Forward (Virtual) | February 2024-EMR with Electrocautery, Avulsion and STSC

EMR with Electrocautery, Avulsion and STSC

Pdf Summary

Endoscopic Mucosal Resection (EMR) is the standard of care for large benign polyps, as it is safer and more cost-effective than surgical resection. The goal of EMR is to safely, completely, and efficiently remove the entire lesion. It is important to avoid referring benign polyps to surgery and to not attempt removing lesions with features of deep invasive cancer. If you are not competent to remove the entire lesion in one attempt, it is best to refer to an expert. Biopsying benign appearing lesions should also be avoided, as it can cause scarring. When performing EMR, several factors are important, including lesion assessment and characterization, stable scope position, adequate submucosal injection lift, and meticulous resection without leaving islands and ridges of adenoma. Margin treatment with techniques like STSC (Snare Tip Soft Coagulation) and APC (Argon Plasma Coagulation) may be necessary. Underwater EMR is a technique that can be used, especially for lesions 2 cm – 4 cm in size. It involves using saline instead of gas for insufflation, which allows mucosal lesions to be removed without damaging the muscularis propria. Cold Snare EMR is also effective for lesions smaller than 20 mm, with studies showing low recurrence rates and no post-procedural complications. It is important to understand the settings of the electrosurgical generator for different actions during EMR. Hot avulsion, CAST (Cold Snare Tip Soft Coagulation), and cap suction techniques are useful for non-lifting portions of the polyp. En bloc resection may be necessary for lesions with suspicion of superficial invasive cancer, and careful evaluation of the margins is crucial. Tip-in EMR has shown higher rates of en bloc and complete resection compared to conventional EMR. In conclusion, EMR is a highly effective technique for large benign polyps, and understanding the appropriate techniques and tools is essential for successful outcomes.

Keywords

Endoscopic Mucosal Resection

EMR

benign polyps

surgical resection

lesion removal

deep invasive cancer

submucosal injection lift

margin treatment

underwater EMR

Cold Snare EMR