ENSURING A SAFER OUTPATIENT SURGERY: IMMEDIATE FOLLOW-UP PROCEDURES AND METHODS OF CLOSURE TO COVER A LARGE DEFECT AFTER COLORECTAL ENDOSCOPIC RESECTION (WITH VIDEOS)

Abstract

Colorectal endoscopic mucosal resection (EMR) is generally carried out as outpatient surgery on a daily basis and is useful for treating Tis (M) carcinomas. EMR is advantageous because the procedure time, expense, and electrical burning of the muscularis propria is reduced compared with ESD. Disadvantages of EMR include difficulty controlling the excision depth and ascertaining whether a free resection margin was included in all circumferences of the lesion at snaring. The convenience of EMR allows for the resection of many lesions at one time; however, based on its aforementioned limitations, it is necessary to observe the ulcer base and incised margin immediately after the snare resection of each lesion.

First, I observe the state of the ulcer floor and confirm the existence of perforation, bleeding, and the visible vessel. Next, I confirm the existence of the residual lesion with magnified endoscopic observation of the incised margin; if this is unclear, I also use image-enhanced endoscopy and chromoendoscopy. If piecemeal EMR was carried out, I carefully observe the lesion margin and ulcer base. If residual lesions are present, I perform additional treatment.

Even after confirming that there is no residual lesion at the incised margin of the ulcer, it may be necessary to prevent the risk of delayed bleeding using clip closure. If conventional clip closure is difficult for large mucosal defects, other endoscopic closure methods may be explored.

In summary, it is necessary to carefully observe the incision, not only before but also after colorectal EMR, and to add the required treatment to the margin to prevent delayed bleeding. These practices ensure that safe and reliable endoscopic surgeries can be performed on outpatients.