Gastroenterology & Endoscopy

Endoscopic Management of Premalignant Lesions

• Gastroenterology and Endoscopy • Season 1 • Episode 22

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The Gastroenterology & Endoscopy Podcast
Episode 147: Endoscopic Management of Premalignant Lesions

Quick Summary:
An evidence-based overview of EMR vs ESD for premalignant lesions, including technique selection, outcomes, and complication rates.

Key Points:
• EMR: Preferred for lesions <15mm, 0.5-1% perforation risk
• ESD: Better for lesions >20mm, 83-98% en bloc resection rate
• Technique selection based on lesion size, location, and suspected invasion
• Watch for delayed bleeding and stricture formation

Essential Reading:
1. ASGE Guidelines on ESD
   https://www.asge.org/docs/default-source/guidelines/asge-guideline-on-endoscopic-submucosal-dissection

2. Cleveland Clinic EMR Protocol
   https://my.clevelandclinic.org/health/treatments/21148-endoscopic-mucosal-resection

3. Mayo Clinic ESD Guide
   https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/esophageal-endoscopic-submucosal-dissection/mac-20552628

Additional Resources:
• Clinical Outcomes Study - https://www.sciencedirect.com/science/article/abs/pii/S0016510712023760
• ESD Technical Analysis - https://pmc.ncbi.nlm.nih.gov/articles/PMC3072634/
• Comparative Review - https://pmc.ncbi.nlm.nih.gov/articles/PMC5824597/
• Technical Developments - https://www.sciencedirect.com/science/article/abs/pii/S0960740422000354

https://www.gastroendopod.com

The Gastroenterology & Endoscopy Podcast
Episode 147: Endoscopic Management of Premalignant Lesions

Host: Welcome to The Gastroenterology & Endoscopy Podcast. Today's topic is endoscopic management of premalignant lesions. Let's dive right in.

The landscape of treating early gastrointestinal neoplasia has dramatically changed thanks to endoscopic techniques. Today, I'll focus on two game-changing approaches: endoscopic mucosal resection, or EMR, and endoscopic submucosal dissection, known as ESD.

EMR is our workhorse for smaller lesions, particularly those above 10mm. Think of it as a sophisticated snare technique - we lift the lesion with fluid injection and remove it using electrosurgical current. It's straightforward, effective, and perfect for most dysplastic polyps.

Now, ESD is our advanced option. We create a fluid cushion, make a careful circumferential cut, and meticulously dissect the lesion from deeper layers. While it takes longer and requires more expertise, it's invaluable for larger lesions over 20mm where we need that perfect en bloc removal.

Here's what you need to know about choosing between them: EMR is quicker and simpler, perfect for most precancerous lesions. But for larger lesions, you might need piecemeal removal, which can complicate your pathology assessment. ESD gives you those impressive en bloc resection rates of up to 98% and very low recurrence rates - we're talking just 0-3%. The trade-off? Longer procedure times and a steeper learning curve.

Speaking of risks - perforation rates are about 0.5-1% with EMR and 5% with ESD. Watch for delayed bleeding with both techniques, and in the esophagus, keep an eye out for strictures, especially with larger circumferential lesions.

Here's my practical take: For esophageal lesions under 15mm, go with EMR. Need to tackle something bigger or suspect submucosal invasion? That's when ESD shines. For gastric lesions, ESD is your friend for early-stage, well-differentiated cancers in the 20-30mm range.

Host: Thanks for listening.