Endoscopic mucosal resection with anchoring of the snare tip: multicenter retrospective evaluation of effectiveness and safety

Abstract

Background Endoscopic mucosal resection (EMR) with snare is the recommended technique to resect non-invasive colorectal neoplastic lesions between 10 and 30 mm in diameter. The objective of EMR is to resect completely the neoplastic tissue en bloc and preferably with free margins (R0), avoiding recurrences. Anchoring the tip of the snare in the submucosa is a technical trick that allows snare sliding to be reduced and larger pieces to be caught. The aim of the present study was to evaluate the effectiveness and safety of anchoring-EMR (A-EMR). Methods This was a retrospective analysis of A-EMR procedures for lesions of diameter between 10 and 30 mm (endoscopic evaluation) performed consecutively in four French centers between May 2017 and January 2018. A-EMR was routinely performed for all EMR using Olympus conventional snares (10 or 25 mm). The primary outcome was evaluation of the proportion of R0 resections. Results A total of 141 A-EMR procedures were performed by 10 operators. Mean lesion size was 19.8 mm. Anchoring was feasible in 96.5 % of cases. There were 81.6 % en bloc resections and 70.2 % R0 resections, with the percentage of procedures decreasing with increasing lesion size (82.8 % < 20 mm, 55.3 % 21 – 30 mm, and 50.0 % > 30 mm, P = 0.002). Complete perforations closed endoscopically occurred in 3/141 cases (2.1 %); none occurred in lesions < 20 mm in size (0 /87). Conclusion The A-EMR technique appears to be promising with a high proportion of R0 for lesions of 10 – 20 mm in size without any perforations. It could also offer an alternative to endoscopic submucosal dissection (ESD), or to hybrid techniques to reach R0 for lesions between 20 and 30 mm in size.

Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

“…Third, both ASEMR and EMR-C were performed by a single expert endoscopist who had expertise in EMR, EMR-P, EMR-C, and ESD. Though learning curve of ASEMR has not been reported so far, previous published literatures on ASEMR have been analyzed primarily for large colorectal polyps (≥ 10 mm), and small NETs (≤ 10 mm) are expected to be much easier than that of large colorectal polyps 19 , 20 , 36 . Furthermore, ASEMR is a minimally modified EMR but is actually very similar to conventional EMR except for making a small mucosal slit and anchoring a snare there, we believe that endoscopists skillful at EMR can easily learn ASEMR.…”

Endoscopic treatment for rectal neuroendocrine tumor: which method is better?

“…39 ASEMR had a shorter procedure time than EMR-C and a similar complication rate that was not significantly different from that of EMR-C. 39 In this study, 11-mm and 12-mm rectal NETs were also completely resected using ASEMR with a 13-mm oval stiff snare, and their deep safety resection margins were 230 μm and 1,900 μm, respectively. Unfortunately, studies on ASEMR for rectal NETs are limited, although there are studies showing that ASEMR increases the complete resection rate and specimen size [49][50][51] ; thus, the potential se of ASEMR in the future may be promising. Therefore, EMR without suctioning (EMR-P and ASEMR methods) using only a simple injector and snare is also useful for the resection of small rectal NETs <10 mm.…”

Anchoring endoscopic mucosal resection versus conventional endoscopic mucosal resection for large nonpedunculated colorectal polyps: a randomized controlled trial

“…and 1 less experienced endoscopist with fewer than 1000 colonoscopic practice cases (O.C.K.). All endoscopists had a self-learning of at least 20 A-EMRs with reference to Japanese and European video sources before the trial was started [10,16]. All the procedures were carried out with a high-definition RGB sequential video-endoscopy system (CV-290; Olympus Co, Tokyo, Japan).…”