EMR USING AN OVER-THE-SCOPE CLIP FOR GASTROINTESTINAL TUMORS (WITH VIDEOS)

Abstract

With the widespread use of EMR and improvements and refinements to conventional EMR, various modified EMR techniques have been developed to ensure complete resection of lesions with negative margins. Recently, the authors have devised a novel modified EMR using an over-the-scope clip (OTSC) called endoscopic mucosal resection using an OTSC (EMR-O). In EMR-O, an OTSC, a device for gastrointestinal full-thickness suturing, is deployed under the lesion in advance, and the lesion is resected using a snare just above the OTSC. Therefore, EMR-O is considered as a “modified EMR without perforation.” EMR-O is suitable for resecting lesions in thin-walled organs, such as the duodenum and colorectum. Depending on the standard OTSC used, the size of resectable lesions is limited to approximately 10-15 mm. In some cases, full-thickness resection is possible, a feature that is unavailable with conventional modified EMR. EMR-O may be an option for endoscopic treatment of gastrointestinal tumors that are difficult to resect using conventional EMR. This article describes the practices of EMR-Os, procedural tips, and treatment outcomes.