Evaluation and long-term outcomes of the different modalities used in colonic endoscopic mucosal resection

Abstract

Endoscopic mucosal resection (EMR) has been used in western countries to remove colonic polyps for at least the last two decades. Significant experience has been accumulated and the efficacy of the method has recently been evaluated in a large meta-analysis. A number of variations to modify the technique, including knife-assisted, cap-assisted, ligation devices, and underwater EMR, have been developed in an attempt to improve outcomes. However, to date there are only limited data comparing these techniques or demonstrating the superiority of any one of them. This article reviews the current evidence on the efficacy of each of these modified techniques.

Endoscopic resection of large colorectal adenomas – clinical experience of a tertiary referral centre

“…In a multivariate regression analysis of factors associated with local recurrence, piecemeal resection was not an independent risk factor [1.70 (0.46-6.27); P = 0.423]. In a review by Gaglia et al [23], the main predictors for recurrence were piecemeal resection and large polyp size. In lesions of 40 mm or more there was more than an eight-fold increase in the incidence of recurrence.…”

Endoscopic Mucosal Resection with Circumferential Incision in Difficult Colorectal Lesions

“…However, several drawbacks, including a technically demanding and time-consuming procedure, long learning curve, and significant risk of complications, limit its colorectal use [1, 3, 4]. Currently, ESD has been proposed for hard-to-resect lesions, such as LST-NG or nonlifting lesions, that otherwise require surgical resection [1, 2, 4, 5]. …”

“…Techniques combining ESD and EMR have been developed to minimize ESD limitations, including EMR with circumferential incision (EMR-CI) and ESD-hybrid (ESD-H) [1, 3-5]. EMR-CI consists in an EMR following circumferential mucosal incision without partial submucosal dissection, avoiding snare slippage [1, 3, 5].…”

“…EMR-CI consists in an EMR following circumferential mucosal incision without partial submucosal dissection, avoiding snare slippage [1, 3, 5]. For large colorectal lesions (>20 mm), ESD revealed superior to EMR-CI or ESD-H due to the higher complete resection rate [2, 4, 5]. However, limited published studies comparing these techniques for lesions <20 mm showed no differences in terms of complete resection or safety [3, 5].…”

“…For large colorectal lesions (>20 mm), ESD revealed superior to EMR-CI or ESD-H due to the higher complete resection rate [2, 4, 5]. However, limited published studies comparing these techniques for lesions <20 mm showed no differences in terms of complete resection or safety [3, 5]. Therefore, EMR-CI can be considered an alternative to ESD without its drawbacks and much less cost than other endoscopic options such as full-thickness resection [4, 5].…”