Endoscopic Mucosal Resection (EMR)

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  • Sigmoid colon polyp EMR with novel endoscopic morcellator

  • Large intramural hematoma and gastric ulcer after EMR of a small gastric polyp

    A 59-year-old man underwent EMR of a 1-cm sessile polyp at the gastric antrum. He had a history of coronary artery disease, chronic kidney disease (creatinine, 460 μmol/L), and compensated liver cirrhosis (platelet count, 144 × 109/L; prothrombin time, 14 s; international normalized ratio, 1.35). He took clopidogrel, which was discontinued 1 week before EMR. We used the inject-and-cut EMR technique and injected the submucosa with 5 mL of saline solution. A small nonexpanding purplish bulge developed after injection (A).
  • EMR of laterally spreading lesions around or involving the appendiceal orifice: technique, risk factors for failure, and outcomes of a tertiary referral cohort (with video)

    Background and Aims
    EMR of sessile periappendiceal laterally spreading lesions (PA-LSLs) is technically demanding because of poor endoscopic access to the appendiceal lumen and the thin colonic wall at the base of the cecum. We aimed to assess the feasibility and safety of EMR for PA-LSLs. Methods
    Consecutive LSLs ≥20 mm and PA-LSLs ≥10 mm detected at 3 academic endoscopy centers from September 2008 until January 2017 were eligible. Prospective patient, procedural, and lesion data were collected. PA-LSLs were compared with LSLs in other colonic locations. Results
    Thirty-eight PA-LSLs were compared with 1721 LSLs. Referral for surgery without an attempt at EMR was more likely with PA-LSLs (28.9% vs 5.1%, P Conclusions
    EMR is a safe, effective, and durable treatment for PA-LSLs when specific criteria are fulfilled. If the distal margin of the PA-LSL within the AO cannot be visualized or if more than 50% of the circumference of the orifice is involved, surgery should be considered. (Clinical trial registration number: NTC01368289.)