Colonic Endoscopic Mucosal Resection Research Articles

CURRENT STATUS OF COLONIC ENDOSCOPIC MUCOSAL RESECTION IN THE WEST AND THE INTERFACE WITH ENDOSCOPIC SUBMUCOSAL DISSECTION

Endoscopic Mucosal Resection (EMR) is now widely practised by western endoscopists to treat large sessile colonic polyps or laterally spreading tumours. Despite its widespread application, the technique of colonic EMR is not standardised. A lesion specific endoscopic treatment approach is also lacking. For lesions larger than 25mm, EMR is limited by its inability to achieve en-bloc resection. En-bloc resection has many theoretical advantages including more accurate histological assessment, reduced recurrence and potentially curative treatment for low risk submucosal invasive neoplasia particularly in patients with significant co-morbidity. Hence, Japanese endoscopists, having pioneered endoscopic submucosal dissection (ESD) in the upper gastrointestinal tract for the en-bloc resection of superficial neoplasia, now advocate the use of ESD for laterally spreading tumours of the colon greater than 25-30mm. This treatment strategy is not widely accepted or practised in the west and has its own inherent problems. The absence of suitable gastric lesions on which to develop ESD skills is also another significant barrier to the development of colonic ESD. It is also possible that modification and refinement in EMR technique may increase the size limit for colonic EMR.

The Australian Multicentre Colonic Endoscopic Mucosal Resection Database (AMCEMRD) - Progress Towards a More Comprehensive Understanding of EMR and Its Outcomes for Laterally Spreading Tumors (LSTs) of the Colon in a Western Population

The Australian Multicentre Colonic Endoscopic Mucosal Resection Database (AMCEMRD) - Progress Towards a More Comprehensive Understanding of EMR and Its Outcomes for Laterally Spreading Tumors (LSTs) of the Colon in a Western Population

Progress Towards the Ideal Submucosal Injection Solution for Endoscopic Mucosal Resection (EMR) - A Randomized Blinded Trial of Succinylated Gelatin (SG) Versus Normal Saline (NS) for Colonic EMR in a Porcine Model

Progress Towards the Ideal Submucosal Injection Solution for Endoscopic Mucosal Resection (EMR) - A Randomized Blinded Trial of Succinylated Gelatin (SG) Versus Normal Saline (NS) for Colonic EMR in a Porcine Model

Standard “inject and cut” endoscopic mucosal resection technique is practical and effective in the management of superficial colorectal neoplasms

Standard polypectomy techniques may be contributing to ineffective eradication of colonic superficial neoplasia, an increasing number of which are nonpolypoid. We aimed to demonstrate the practicality and efficacy of the "inject and cut" endoscopic mucosal resection (EMR) technique in routine clinical practice. Colonic EMRs performed for polypoid and nonpolypoid lesions at a tertiary institution were prospectively collected and analyzed for efficacy, and short and long-term complications. 224 colonic neoplasms (143 flat, 65 sessile and 16 subpedunculated) were excised by the standard inject-and-cut method, with standard accessories. The median size of all lesions was 10 mm (range 2-50 mm) and 110 (49.2%) lesions were located in the proximal colon. Histological completeness of resection was achieved in 87% of cases. Of the lesions 77.2% were dysplastic, with 5 cases of carcinoma in situ and 18 severely dysplastic adenomas. Complications included bleeding in five cases (2.2 %) and a single case of perforation (0.4%). All complications were managed endoscopically. Median follow up at 24 +/- 16 months (range 12-84 months) revealed a 7.2% local recurrence rate, all of which were subsequently eradicated by repeat EMR. Standard inject-and-cut colonic EMR is practical and effective in the eradication of superficial colonic neoplasia.