A national survey of endoscopic mucosal resection for superficial gastrointestinal neoplasia

Abstract

EMR in general, especially saline-assisted polypectomy in the colon, appears to be reasonably safe even when performed by nonexperts. EMR for larger or for upper gastrointestinal lesions should probably be limited to high-volume centers.

Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps

“…Early bleeding has been the most frequently observed complication, occurring in up to 33% of patients (Tables 3 and 4). 10,28,29,40,[44][45][46][47][48][49][50][51][52] The number of patients enrolled in these studies is limited because of the low prevalence of these lesions and also because large lesions were treated surgically. 1,11,12 53,54 The American Society for Gastrointestinal Endoscopy guidelines suggest considering surgical resection for duodenal lesions that involve Ͼ33% of the luminal circumference, because of the difficulty of radical endoscopic removal.…”

“…27 Cap-assisted EMR (EMR-C) has been used rarely to treat sporadic duodenal polyps. 28,29 There is concern that EMR-C may be associated with a higher rate of perforation because of the possibility of inadvertently grasping the muscularis propria of the duodenal wall. Previously, we published our experience of the safety and efficacy of EMR-C for colon lesions.…”

Factors associated with increased bleeding post‐endoscopic mucosal resection

“…Endoscopic mucosal resection (EMR) has evolved as a safe technique to remove flat/sessile lesions in the GI tract. EMR has been used mostly for colorectal and esophageal lesions . However, it can also be used for selected patients with gastric or duodenal lesions .…”

Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions

“…EMR to have a high risk of perforation, with rates of less than 5% reported for large colon lesions (51,52). Risk factors for post-EMR perforation include a large lesion size and location in the right colon.…”