Problems With Colorectal EMR Training for Some GI Fellows

Problems With Colorectal EMR Training for Some GI Fellows

Douglas K. Rex, MD, MASGE, reviewing Garg S, et al. Endosc Int Open 2021 Aug.

In a 2019-2020 academic year survey of all 1730 GI fellows in the U.S. regarding endoscopic mucosal resection (EMR) training and knowledge, the response rate was 9.4%. Most of the respondents were second- or third-year fellows, 70% did not plan on doing an advanced endoscopy fellowship, and 63% reported that EMR was performed by general GI and advanced endoscopy faculty, whereas 31% said that only advanced endoscopists performed EMR at their center.

Seventy-eight fellows (48%) reported no formal education or training in EMR. Areas of deficiency included the inability to arrange 6 basic steps of EMR in sequence (44.8%) and identify the correct current types for EMR (57.1%). Adenoma assessment (by the Paris and Narrow-Band Imaging International Colorectal Endoscopic classifications) was deficient. Predictors of higher EMR knowledge level included higher fellowship year, male sex, and availability of an advanced endoscopy rotation at their center.

Douglas K. Rex, MD, FASGE


Colorectal EMR may be an area that some GI fellows will want to discuss with their fellowship director to explore whether a more systematic approach to EMR education and experience is warranted.

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.


Garg S, Inamdar S, Tharian B, Muniraj T, Aslanian HR. Education and gastroenterology fellow knowledge about endoscopic mucosal resection of colon adenomas: a survey-based study. Endosc Int Open 2021;9:E1227-E1233. (

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