Endoskopische Mukosaresektion (EMR) – Schritt für Schritt

AbstractColonoscopy with polypectomy has been shown to reduce the risk of colon cancer development. It is considered a fundamental skill for all endoscopists who perform colonoscopy. A variety of polypectomy techniques and devices are available, and their use can vary greatly based on local availability and preferences. Polyps that are difficult to remove due to location or size require advanced resection techniques, such as endoscopic mucosal resection (EMR) and the use of special devices for safe and effective removal. However, colonic EMR is not routinely part of the standard endoscopic curriculum that is normally offered to gastroenterologists. It requires dedicated training in advanced endoscopic resection techniques, clinical and interpretive skills, and the knowledge and ability to manage complications.The two most common post-polypectomy complications are bleeding and perforation. Their frequency can be limited with the use of meticulous polypectomy techniques and the application of some prophylactic manoeuvres.This paper gives a review of the step by step technique of polypectomy and its complications from the perspective of the practicing gastroenterologist.

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Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection

Visceral Medicine ◽

10.1159/000515354 ◽

2021 ◽

pp. 1-14

Author(s):

Arthur Hoffman ◽

Raja Atreya ◽

Timo Rath ◽

Markus Ferdinand Neurath

Keyword(s):

Endoscopic Mucosal Resection ◽

Endoscopic Resection ◽

Complication Rates ◽

Full Thickness ◽

National Guidelines ◽

En Bloc ◽

Early Stages ◽

Mucosal Resection ◽

Submucosal Dissection ◽

Gastrointestinal Lesions

Background: Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4–1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. Summary: Endoscopic treatment is now regarded as first-line therapy for benign lesions. Key Message: Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.

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1028 - Endoscopic Resection of Duodenal Carcinoid Tumors: A Single Center Comparison Between Simple Polypectomy and Endoscopic Mucosal Resection

Gastroenterology ◽

10.1016/s0016-5085(18)31060-6 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-196-S-197

Author(s):

Nadim Mahmud ◽

Yutaka Tomizawa ◽

Kristen M. Stashek ◽

Bryson W. Katona ◽

David C. Metz

Keyword(s):

Endoscopic Mucosal Resection ◽

Endoscopic Resection ◽

Carcinoid Tumors ◽

Single Center ◽

Mucosal Resection ◽

Duodenal Carcinoid

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Validation of the size morphology site access score in endoscopic mucosal resection of large polyps in a district general hospital

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0068 ◽

2019 ◽

Vol 101 (8) ◽

pp. 558-562

Author(s):

AC Currie ◽

H Merriman ◽

S Nadia shah Gilani ◽

P Mackenzie ◽

MR McFall ◽

...

Keyword(s):

General Hospital ◽

Endoscopic Mucosal Resection ◽

Endoscopic Resection ◽

Hospital Setting ◽

District General Hospital ◽

Colorectal Polyps ◽

Incomplete Resection ◽

Mucosal Resection ◽

Histological Data ◽

The Right

Background Polyp assessment is multimodal and is vital prior to endoscopic mucosal resection. The size, morphology, site and access (SMSA) score has been validated in specialist endoscopic institutions. this study investigated the ability of this score to predict incomplete endoscopic resection of large colorectal polyps in a district general hospital Methods Consecutive patients undergoing endoscopic mucosal resection of large (≥ 20 mm) colorectal polyps at Worthing Hospital. Clinical, endoscopic and histological data were taken from prospective databases. The primary outcome of the study was to investigate the correlation of the SMSA score with incomplete endoscopic resection. Results Between February 2015 and August 2018, 114 patients underwent colorectal endoscopic mucosal resection. Of these, 67 (59%) were male. The median (interquartile range) age of the study population was 72 years (65–78 years). Some 17 lesions (15%) were pedunculated, 76 (67%) were sessile and 21 were (18%) flat; 84 polyps (77%) were located in the left colon/rectum, with the remainder in the right colon; 51 lesions (45%) were 20–30 mm, 27 (24%) were 30–40 mm and 36 (31%) were greater than 40 mm in diameter. When reclassified into the SMSA score, 9 of the polyps (8%) were level 2, 64 (56%) were level 3 and 41 (36%) were level 4. Incomplete resection was clinically diagnosed in 9/114 (8%). The SMSA score was positively correlated with incomplete endoscopic resection, but not with additional procedure usage, complications or advanced histology. Conclusions Many patients with large polyps can be managed outside of specialist units. This study has validated that the SMSA score was associated with incomplete endoscopic mucosal resection for large polyps in a district general hospital setting.

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