Should We Mark the Margins Before EMR?
Douglas K. Rex, MD, MASGE, reviewing Yang D, et al. Gastrointest Endosc 2021 Nov 30.
One approach sometimes used in endoscopic mucosal resection (EMR) to improve complete resection is to use cautery to mark the normal tissue at the margins of the lesion and then extend the resection to the marks. This helps to ensure complete resection.
In a single-center study with historical controls, 210 patients, each of whom had a lesion with a median size of 30 mm, underwent either EMR with margin marking (EMR-MM; n=74) or conventional EMR (n=136). The recurrence rates at 6 months were 8% with EMR-MM and 29% with conventional EMR. There was no increased rate of adverse events with EMR-MM. On multivariable analysis, both EMR-MM (odds ratio [OR], 0.20) and increased polyp size (OR, 2.81) predicted recurrence.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Yang D, Draganov PV, King W, et al. Margin marking before colorectal endoscopic mucosal resection and its impact on neoplasia recurrence (with video). Gastrointest Endosc 2021 Nov 30. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.11.023)