Endoscopic mucosal resection and complications

Flat and sessile colonic lesions are being identified more frequently because of increased awareness, improved endoscopic skills, and enhanced imaging. Endoscopic mucosal resection (EMR) is now a well-developed technique in the treatment of large sessile lesions and advanced mucosal neoplasia of the colon. Significant cost, morbidity, and mortality benefits may be obtained from this minimally invasive technique. Careful lesion assessment is mandatory, and the patient's general health and comorbidities should be factored into the therapeutic plan. Recent technical advances allow resection of larger and more complex lesions in excess of 50 mm and involving more than two-thirds of the circumference of the colonic wall as an outpatient. Meticulous resection technique is crucial to maximize procedural success. EMR is associated with a small, but significant, risk of bleeding and perforation. Endoscopists need to be aware of risk factors for these events and techniques of early detection. Early identification and endoscopic treatment ameliorates the frequency and severity of adverse events. This review will discuss the general principles of EMR, including lesion assessment, equipment selection, endoscopic technique, and early identification and treatment of complications.