Tip 10: Cold EMR for Large Conventional Adenomas | March 2021-Cold EMR for Large Conventional Adenomas

Video Transcription

Video Summary

In this video, the speaker discusses the possibility of extending cold EMR (endoscopic mucosal resection) to treat large flat adenomas. The advantages of cold EMR include a lower complication rate, especially delayed hemorrhage. Factors associated with delayed hemorrhage after EMR are large diameter and proximal location, but it appears that these factors do not apply to lesions removed without electrocautery. However, there may be a higher recurrence rate with cold EMR, which requires further study. The best candidates for cold EMR of large adenomas are flat lesions without nodules or evidence of cancer. The technique for cold EMR is similar to removing SSLs (sessile serrated lesions) and involves a slow and systematic approach. The video provides examples of cold EMR procedures on different lesions and the speaker emphasizes the need for careful examination and the removal of any residual adenoma. Clip closure and the use of electrocautery are not necessary for cold EMR. The speaker also discusses the benefits of using cold EMR for a lesion on the medial wall of the cecum where clip closure is difficult. Finally, a case study of a granular lateral spreading tumor in the ascending colon is presented, highlighting the considerations for using cold EMR in clinical practice. The speaker concludes by mentioning that recurrence management and bleeding risk associated with larger lesions need to be further studied. The video is part of the ASGE SuTab tip of the week series.

Keywords

cold EMR

endoscopic mucosal resection

large flat adenomas

delayed hemorrhage

recurrence rate