1997 Volume 50 Pages 164-167
We have practiced endoscopic mucosal resection (EMR) for the lesions which have a possibility of incomplete resection by snare polypectomy or hot biopsy, or the lesions which required histological complete resection. The lesions apparently invading in the deep submucosal layer were excluded from the indication for EMR.
In this report, we studied 478 cases of EMR regarding the technique and the complications after EMR. The procedures of EMR in our practice were as follows. First, we observed the lesions with dye spray technique in detail, and we decided the details of the method including the site of saline injection, the number of sites of saline injection and the injecting speed of saline according to the shape, size and site in colorectum. In some cases we pricked the lesions directly with a needle for injecting saline. When lesions were located in the caecum or the rectum, we rapidly injected saline with a full strength. When lesions were under 15 mm in size, we usually used smaller-sized snare wire (called mini-elliptic type) . When patients had a bleeding diathesis, we basically closed mucosal defect with clips to prevent delayed bleeding.
In 478 cases of EMR, we experienced no perforation, 16 immediate bleedings after EMR and 3 delayed bleedings. 16 immediate bleedings could be controlled endoscopically and got permanent hemostasis. Two of 3 cases with delayed bleeding showed minor bleeding on colonoscopy, and another case revealed venous bleeding which was controlled by clipping. One of 20 cases with closure of mucosal defect following EMR showed delayed bleeding. There was no local recurrence except for only one patient with multinodular lesion of 40 mm in size. Residual tumor tissue was not present in the surgically resected specimens of the 4 cases in which subsequent bowel resection was indicated because of the unfavorable histology on EMR specimens.
In conclusion, EMR is appropriate method for the purpose of getting histological complete resection, because the frequency of complication in EMR is almost as low as in that of snare polypectomy or hot biopsy.
