Tip 38: A Challenging EMR: The Large, Bulky Colorectal Lesion | November 2021-A Challenging EMR: The Large, Bulky Colorectal Lesion

Video Transcription

Video Summary

In this video, Dr. John Deviere discusses the challenges of removing large Paris 1S lesions in the ascending colon using endoscopic mucosal resection (EMR). He explains that it's difficult to predict the presence of cancer based on surface features, with surface assessment having a lower sensitivity compared to flat lesions. He suggests that, due to the low absolute risk of cancer in the ascending colon, it is acceptable to remove these lesions by EMR rather than by surgery. He also discusses the challenge of using snares that are not big enough to fully encompass these bulky lesions. Dr. Deviere demonstrates the technique of anchoring the snare on normal mucosa to start transecting in the submucosal plane. He notes that large sessile polyps may have areas of fibrosis that can be removed using the CAP technique or avulsion. The video concludes with Dr. Deviere showing the complete transection of the lesion and discussing the need for clip closure to reduce the risk of bleeding. The next week's video teaser is about accessing a difficult lesion in the cecum.

Keywords

endoscopic mucosal resection

Paris 1S lesions

ascending colon

cancer risk

snares