How to Perform High-Quality Endoscopic Mucosal Resection During Colonoscopy.

Colonoscopy with polypectomy reduces mortality from colorectal cancer. A small fraction of polyps are>2 cm and termed lateral spreading lesions (LSLs) of the colon. These polyps require advanced resection techniques such as endoscopic EMR. It is important to emphasize to the patient the differences between standard polypectomy and EMR, and to ensure the patient is fully consented to the procedure and its alternatives. Thepatient’smedical history includingmedication list need to be reviewed thoroughly and the patient’s comorbidities constantly factored into the therapeutic process. Be prepared and organized. Preferably, a dedicated list should be scheduled for such procedures. All the required equipment should be readily available in the endoscopy suite and both physician and nurse need to be familiar with their use (Table 1). Before commencing resection, take time to meticulously inspect the lesion with high-definition white light and mucosal resection (EMR) for safe and effective removal. However, colonic EMR is not routinely part of the general endoscopic curriculum available to gastroenterologists upon completion of their training. It requires dedicated training in advanced endoscopic resection techniques, the acquisition of clinical and interpretive skills, and the knowledge and ability to manage complications. Performing high-quality, safe, and effective colonic EMR requires a team effort both inside and outside the endoscopy suite. To achieve this, colonic EMR for advanced lesions should be performed preferably in tertiary referral centers. This provides a large case volume for training fellows and the opportunity for a multidisciplinary team structure including surgical, radiologic, and anesthetic support. This multifaceted and comprehensive approach provides the necessary context for advanced endoscopic tissue resection procedures. Over the last decade, a steady accumulation of scientific evidence has elucidated the technical aspects of colonic EMR, including safety and efficacy, long-term outcomes, and the clinical and economic benefits comparedwith surgery. An intimate knowledge of the evidence base is critical to achieve technical competence. Herein we review the step-by-step evidence-based methodology for performing best practice colonic EMR.