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Lower GI EMR Definition

Endoscopic musical resection (EMR) for the Lower GI tract is defined as the use of various snares, cautery and injection/lifting technique in the resection of large, complex or high-risk colonic polyps.

Enrollment Criteria 

The enrollment criteria described below is intended to give potential participants an idea of the basic skill levels expected of the program participants, and the skills that are needed to successfully perform lower GI EMR.  Enrollees should have: 

  • A minimum of two years in practice post-fellowship
  • Performed at least 500 colonoscopies independently, and currently performing colonoscopy as part of daily practice
  • Proficiency in basic polypectomy, hemostasis, and injection techniques

Learning Objectives

  • Describe the morphology of colonic polyp and assess their endoscopic appearance for resectability
  • Appropriately select and demonstrate the use of various snares, cautery and injection/lifting technique in endoscopic mucosal resection of "large, complex or high-risk" colonic polyps (e.g., >20 mm, difficult location, with depression or significant nodularity).
  • Demonstrate the use of appropriate accessories for both polyp retrieval and adverse event management
  • Select appropriate surveillance intervals based on current guidelines 

Skills to be Covered

  • Lesion Recognition
  • Submucosal Injection Techniques
  • Piecemeal and Snare Resection
  • Polyp Retrieval
  • Polypectomy Site Treatment
  • Tattooing
  • Perforation & Adverse Event Management
  • Communication Skills


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