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

Video Transcription

Video Summary

In this video, the speaker discusses various aspects of endoscopic mucosal resection (EMR). EMR is a standard of care for large benign polyps, as it has been shown to be safer and more cost-effective than surgical dissection. The goal of EMR is to remove the entire polyp safely, completely, and efficiently. The speaker emphasizes the importance of not referring benign-appearing polyps to surgery and not attempting to remove lesions with features of invasive cancer. They also recommend not biopsying benign-appearing lesions and not tattooing in certain areas. The speaker discusses the tools and techniques used in EMR, including high definition scopes, electronic chromoendoscopy, CO2, injection needles, various solutions for raising polyps, different types of snares, coag grasper forceps, hot biopsy forceps, APC clips, and microprocessor controlled electrosurgical generators. They explain the basic points in technique, such as assessing and characterizing the lesion, ensuring good scope positioning, bringing the lesion into an ideal position, creating a submucosal lift, and meticulous resection and margin treatment. The speaker also discusses the use of underwater EMR and cold snare EMR for select lesions, as well as techniques for dealing with difficult non-lifting portions of polyps. They discuss electrocautery settings and generator, as well as the importance of good injection technique. Finally, the speaker mentions the use of on-block resections for lesions with features of superficial invasive cancer.

Asset Subtitle

Amit Rastogi, MD, FASGE

Keywords

Endoscopic mucosal resection

EMR

Benign polyps

Surgical dissection

Invasive cancer

High definition scopes

Chromoendoscopy

CO2 injection

Snares

Electrosurgical generators