Tissue Resection Flashcards
What is R0?
Complete resection of the target lesion
Microscopically margin-negative resection, in which no gross or microscopic tumor remains in the primary tumor bed
What is R1?
En-bloc but histologically positive margin
What are the methods for tissue resection?
Snare Polypectomy
EMR
ESD
Hybrid
What is EMR?
Endoscopic Mucosal Resection (EMR)
Minimally invasive, endoscopic removal of benign and early malignant lesions in the GI tract.
This procedure is indicated for lesions confined to the mucosa or top layers of the submucosa of the colon.
What is the right opportunity for ESD?
Typically for lesions >2cm
Dysplasia or early cancer confined to the mucosa or superficial submucosa
No lymph node metastasis
Provides curative resection
What are the two types of hybird procedures?
Pre-cut EMR includes circumferential incision with an electrosurgical knife and then a snare for removal.
Hybrid ESD includes circumferential incision with an electrosurgical knife, small amount of dissection, and then finish with a snare.
Is perforation higher with EMR or ESD?
1.40% with EMR
5.70% with ESD
How does recurrence rate differ between EMR & ESD?
12.20% with EMR
0.90% with ESD
What are some techniques to reduce reoccurence in EMR?
Include healthy mucosa for improved lateral margins
Snare tip soft coag
How is esophageal EMR performed?
Esophageal EMR is accomplished with band ligation EMR vs snare; this is referred to as EMR ligation
Why do we inject the submucosal?
The die helps you define the borders and the submucosal injection helps you provide a cushion so you don’t cause thermal injury to the muscle layer
To minimize risk of deep thermal injury, bleeding and perforation
Adding a coloring dye assists in presentation of polyp margins and identification of submucosal plane
Identification of residual polyp after resection
Improves recognition of perforations
What do we use to inject for EMR/ESD?
Saline
May add epinephrine prophylactically
May combine viscous agent and coloring dye (methylene blue or indigo carmine)
What does it mean when the submucosal won’t lift?
Cancer - Invading into the submucosa
Prior manipulation
Whether a lesion has been biopsied or incomplete resected (Causes fibrosis)
What is our Interject Needle used for?
This product can be used to give Eppi for hemostasis or injection for EMR.
