Hot Endoscopic Mucosal Resection (EMR) - Polyp Resection Techniques



Technique:

The polyp is initially lifted by submucosal iniection (or underwater) and the polyp is removed typically in piecemeal with closure of the snare, cutting tissue with use of cautery, removing all visible polyp and a margin of normal tissue and/or coagulation of margins.

Indications:

 • En bloc resection for lesions 10-19mm

 • Piecemeal resection for low-risk lesions ≥20mm

Limitations:

 • Size of individual pieces limited due to risk of deep muscle injury if grasp too large of an area, and so not ideal for en bloc resection of a larger suspected cancer

 • Diminished effectiveness in non-lifting polyps with submucosal scarring

 • Adverse events associated with use of cautery (delayed bleeding, post-polypectomy syndrome, or perforation)

 • Risk of incomplete resection requires surveillance colonoscopy at short interval (generally 6 months)



Dr. Enrik Aguila @enrrikke



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