Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice

BO_Bilal_EMRVSESD

Pdf Summary

The document, presented by Dr. Mohammad Bilal, discusses various techniques for the resection of colon polyps, specifically comparing Endoscopic Submucosal Dissection (ESD) and Endoscopic Mucosal Resection (EMR). Dr. Bilal, an expert in advanced endoscopic methods, aims to elucidate the best resection technique for different types of lesions, emphasizing safe removal and reduced recurrence.<br /><br />Key objectives include understanding the significance of lesion inspection and choosing the appropriate resection method. The document highlights different classification systems like the Paris, NICE, and Kudo’s classifications, which assist in predicting deep submucosal invasion crucial for determining the malignancy potential of polyps.<br /><br />Several approaches to EMR are discussed, such as hot snare, cold snare, and underwater EMR, outlining materials, procedures, and specific techniques like treating the edges to minimize recurrence. Cold EMR is noted for its negligible risk of delayed bleeding and cost-effectiveness, while underwater EMR shows higher en-bloc resection rates and reduced recurrence.<br /><br />ESD, while having higher en-bloc resection rates and offering better pathological assessment, presents more adverse events compared to EMR. ESD is particularly recommended for lesions with a risk of submucosal cancer invasion.<br /><br />The document also mentions procedural considerations, potential complications, and their management, emphasizing early recognition and endoscopic management for complications like bleeding and perforation.<br /><br />Dr. Bilal highlights personalized approaches, advising on integrating advanced techniques based on lesion type, size, location, and patient risk factors. He also discusses tools like suturing devices for defect closure, emphasizing the importance of careful inspection, thorough preparation, and knowing when to enlist help for advanced techniques.

Keywords

Endoscopic Submucosal Dissection

Endoscopic Mucosal Resection

colon polyps

lesion inspection

Paris classification

NICE classification

Kudo’s classification

submucosal invasion

en-bloc resection

procedural complications