Modified endoscopic mucosal resection techniques for treating precancerous colorectal lesions

Abstract

Endoscopic mucosal resection (EMR) is a technique allowing efficacious and minimally invasive resection of precancerous lesions across the entire gastrointestinal tract. However, conventional EMR, involving injection of fluid into the submucosal space, is imperfect, given the high rate of recurrence of post-endoscopic resection adenoma, especially after piecemeal resection. In light of these observations, modifications of the technique have been proposed to overcome the weakness of conventional EMR. Some of them were designed to maximize the chance of en bloc resection—cap-assisted EMR, underwater EMR, tip-in EMR, precutting, assisted by ligation device—while others were designed to minimize the complications (cold EMR). In this review, we present their modes of action and summarize the evidence regarding their efficacy and safety.

Cold endoscopic mucosal resection versus cold snare polypectomy for colorectal lesions: a systematic review and meta-analysis of randomized controlled trials

“…A metaanalysis of sessile serrated polyps>10 mm reported lower delayed bleeding rates for C-EMR compared with conventional EMR [32]; however, there was still uncertainty as to whether C-EMR could reduce AEs relative to CSP. C-EMR could theoretically bring more safety to endoscopic resection and protect against perforations through the submucosal cushion it provides [17]. But our series showed only one occurrence of perforation in the control group (1111 CSP procedures), raising doubts about the need to perform routine C-EMR to prevent such an infrequent event.…”

“…Most of the available evidence regarding the efficacy of C-EMR for the resection of colorectal polyps is derived primarily from observational studies [13,14,15,16,29]. A recent metaanalysis of observational studies describing C-EMR reported a complete resection rate of 96.3% for the resection of colorectal polyps ≤20 mm and a single-arm meta-analysis showed a complete resection rate of 99.1% when analyzing C-EMR in polyps ≥10 mm [17,18,30]. The incomplete resection rate was also very low (3.8%) with C-EMR for 4-20 mm polyps in a recent observational study [31].…”

Wound infection prevention strategies in colorectal endoscopic mucosal resection: A meta‐analysis of prophylactic measures

“…1 Endoscopic mucosal resection (EMR) is the minimally invasive procedure enabling resection of precancerous lesions and earlystage malignancies in the gastrointestinal tract, and is one of the most important therapeutic procedures used to treat colorectal polyps. 2,3 The EMR procedure commences by inserting the endoscope through anus to reach the target area. The lesion is identified and a solution is injected into submucosal layer underneath it to elevate the lesion away from the deeper layers of bowel wall.…”

“…The escalating incidence of colorectal polyps worldwide and possibility of their transformation into colorectal cancer have highlighted the critical need for early detection and intercession 1 . Endoscopic mucosal resection (EMR) is the minimally invasive procedure enabling resection of precancerous lesions and early‐stage malignancies in the gastrointestinal tract, and is one of the most important therapeutic procedures used to treat colorectal polyps 2,3 …”

“… 1 Endoscopic mucosal resection (EMR) is the minimally invasive procedure enabling resection of precancerous lesions and early‐stage malignancies in the gastrointestinal tract, and is one of the most important therapeutic procedures used to treat colorectal polyps. 2 , 3…”