Piecemeal EMR versus ESD
What should our patient outcome goals be for endoscopic resection of large colorectal lesions? What limitations should we consider with EMR? What limitations should we consider with ESD? Which procedure is best for safe, efficient and complete resection of the target tissue?
Listen to Dr. Draganov review factors associated with submucosal invasion, including non-granular LST, recto-sigmoid location, increasing size and Paris classification. Indications for use of ESD will also be highlighted: suspected cancer with superficial submucosal invasion (non-granular LST, large granular LST) and anticipated submucosal fibrosis (prior EMR attempt, tattoo underneath the lesion and recurrent lesion).
Dr. Bourke will review why ESD is the standard of care for early gastric cancer and squamous cell cancer while also providing a rationale for why EMR is the standard of care for colon procedures. A review of various studies and publications on wide-field EMR and ESD for colorectal lesions will be highlighted. Dr. Bourke will suggest the rationale and need for using selective treatment algorithms for patients.
Both presentations will provide you with highlights on the use of ESD and EMR and the factors to consider in making the right choice for the patient.
Estimated viewing time: 12 minutes
Authors
Dr. Peter Draganov, MD
Professor of Medicine
Division of Gastroenterology, Hepatology and Nutrition
University of Florida
Dr. Michael Bourke, MD
Professor of Medicine
University of Sydney
Director Gastrointestinal Endoscopy
Westmead Hospital
Learning Objectives
- Compare and contrast the indications for use of EMR or ESD in the resection of colorectal lesions.
- Review studies and publications presented on what factors to consider on the use of EMR and ESD that is most appropriate for the patient.
Target Audience
Practicing Gastroenterologists and GI Fellows
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