Tip-In EMR Increases En Bloc Resection Rate for 15- to 25-mm Colorectal Lesions
Douglas K. Rex, MD, MASGE, reviewing Imai K, et al. Am J Gastroenterol 2021 Jul 1.
Tip-in EMR is a method of anchoring the snare tip in the submucosa before snare resection. First, a mound of submucosal injection is created. Then, with the snare tip projecting out just a couple of millimeters and with electrocautery set in the cutting mode, a small incision is made using the snare tip on the proximal or cecal side of the lesion. The tip is then anchored in the submucosa, opened over the lesion, and closed with a margin of normal tissue.
In a randomized trial involving 41 patients in each lesion-resection group, Tip-in EMR resulted in en bloc resection in 90.2% of patients versus 73.1% undergoing standard EMR. There was no increase in complications or duration of the procedure with the Tip-in method.
COMMENTThe Tip-in method offers a simple way to achieve en bloc resection for 15- to 25-mm lesions. Underwater resection also increases the chance of en bloc resection for polyps in this size range.
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.
CITATION(S)
Imai K, Hotta K, Ito S, et al. Tip-in endoscopic mucosal resection for 15- to 25-mm colorectal adenomas: a single-center, randomized controlled trial (STAR Trial). Am J Gastroenterol 2021;116:1398-1405. (https://doi.org/10.14309/ajg.0000000000001320)
