This GI & Hepatology News Perspectives article provides practical guidance from experienced endoscopists on two key endoscopic topics: the management of Barrett’s esophagus and the endoscopic mucosal resection (EMR) of large colorectal polyps. Rather than focusing on guidelines alone, the authors share real-world techniques, procedural decision-making, and lessons learned from high-volume clinical practice.
For large colorectal polyps, Dr. Gottumukkala S. Raju emphasizes that successful EMR begins long before the first snare is deployed. Careful patient selection, procedural planning, lesion assessment, and ensuring the right equipment and support are available are all critical. Factors such as upcoming travel, patient support at home, and whether the lesion should be removed during the initial colonoscopy or scheduled for a dedicated EMR session are considered part of the procedure itself rather than separate logistical issues.
The article outlines a disciplined technical approach to EMR, highlighting the importance of achieving stable scope positioning, thoroughly inspecting lesion morphology to exclude invasive cancer, and creating an adequate submucosal lift before resection. The author favors conventional hot EMR using saline mixed with dye for submucosal injection, followed by careful snare resection with minimal thermal injury. Residual tissue should be removed completely, and every resection defect should be meticulously inspected, photographed, treated with margin ablation when appropriate, and closed with clips to reduce recurrence and complications.