Dual Channel Endoscopic Mucosal Resection

Abstract

Endoscopic mucosal resection (EMR) is the recommended technique for colon polypectomy for nonpedunculated lesions that are >20 mm in size not requiring excision. Dual-channel EMR (DC-EMR) uses an endoscope with two working channels to facilitate easier submucosal injection, snare resection, and clip closure of polypectomy defects. There is also promising early literature indicating that this endoscopic modality can reduce the overall learning curve present for single-channel colonoscopy EMR. This chapter will describe the steps and techniques required to perform DC-EMR, potential complications, recommended postprocedure surveillance, and future directions.

Keywords

EMR - dual-channel EMR - single-channel EMR - endoluminal surgery

• References

• 1 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366 (08) 687-696
• 2 Kaltenbach T, Anderson JC, Burke CA. et al. Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on colorectal cancer. Gastroenterology 2020; 158 (04) 1095-1129
• 3 Burgess NG, Hourigan LF, Zanati SA. et al. Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicenter cohort. Gastroenterology 2017; 153 (03) 732-742.e1
• 4 Vu JV, Sheetz KH, De Roo AC, Hiatt T, Hendren S. Variation in colectomy rates for benign polyp and colorectal cancer. Surg Endosc 2021; 35 (02) 802-808
• 5 Hassan C, Repici A, Sharma P. et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65 (05) 806-820
• 6 Keswani RN, Law R, Ciolino JD. et al. Adverse events after surgery for nonmalignant colon polyps are common and associated with increased length of stay and costs. Gastrointest Endosc 2016; 84 (02) 296-303.e1
• 7 Swan MP, Bourke MJ, Alexander S, Moss A, Williams SJ. Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (with videos). Gastrointest Endosc 2009; 70 (06) 1128-1136
• 8 Tada M, Murakami MSF, Mizumachi M. et al. Development of strip-off biopsy. Gastrointest Endosc 1984; 26: 833-839
• 9 Yang D, Perbtani YB, Wang Y. et al; C-EMR STAT Study Group. Evaluating learning curves and competence in colorectal EMR among advanced endoscopy fellows: a pilot multicenter prospective trial using cumulative sum analysis. Gastrointest Endosc 2021; 93 (03) 682-690.e4
• 10 Rajendran A, Pannick S, Thomas-Gibson S. et al. Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy. Colorectal Dis 2020; 22 (09) 1085-1100
• 11 Cho EAT, Nakajima M. et al. Clinical evaluation of prototype 2-channels electronic videocolonoscope (CF-2T200I). Gastrointest Endosc 1993; 35: 289-294
• 12 Voudoukis E, Tribonias G, Tavernaraki A. et al. Use of a double-channel gastroscope reduces procedural time in large left-sided colonic endoscopic mucosal resections. Clin Endosc 2015; 48 (02) 136-141
• 13 Yandrapu H, Desai M, Siddique S. et al. Normal saline solution versus other viscous solutions for submucosal injection during endoscopic mucosal resection: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85 (04) 693-699
• 14 Kemper G, Turan AS, Schoon EJ. et al; ENDOCARE Study Group. Endoscopic techniques to reduce recurrence rates after colorectal EMR: systematic review and meta-analysis. Surg Endosc 2021; 35 (10) 5422-5429
• 15 Pohl H, Grimm IS, Moyer MT. et al. Effects of blended (yellow) vs forced coagulation (blue) currents on adverse events, complete resection, or polyp recurrence after polypectomy in a large randomized trial. Gastroenterology 2020; 159 (01) 119-128.e2
• 16 Pohl H, Grimm IS, Moyer MT. et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 2019; 157 (04) 977-984.e3
• 17 Albéniz E, Álvarez MA, Espinós JC. et al. Clip closure after resection of large colorectal lesions with substantial risk of bleeding. Gastroenterology 2019; 157 (05) 1213-1221.e4
• 18 Ortiz O, Rex DK, Grimm IS. et al. Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps. Endoscopy 2021; 53 (11) 1150-1159
• 19 van Hattem WA, Shahidi N, Vosko S. et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut 2021; 70 (09) 1691-1697
• 20 Ahmed Y, Othman M. EMR/ESD: techniques, complications, and evidence. Curr Gastroenterol Rep 2020; 22 (08) 39
• 21 van der Star S, Moons LMG, Ter Borg F. et al. Management of delayed bleeding after endoscopic mucosal resection of large colorectal polyps: a retrospective multi-center cohort study. Endosc Int Open 2020; 8 (08) E1052-E1060
• 22 Nishizawa T, Suzuki H, Goto O, Ogata H, Kanai T, Yahagi N. Effect of prophylactic clipping in colorectal endoscopic resection: a meta-analysis of randomized controlled studies. United European Gastroenterol J 2017; 5 (06) 859-867
• 23 Hwang JH, Konda V, Abu Dayyeh BK. et al; ASGE Technology Committee. Endoscopic mucosal resection. Gastrointest Endosc 2015; 82 (02) 215-226
• 24 Dib Jr J. Post-polypectomy syndrome. Am J Gastroenterol 2017; 112 (02) 390
• 25 Hirasawa K, Sato C, Makazu M. et al. Coagulation syndrome: delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 2015; 7 (12) 1055-1061
• 26 Cha JM, Lim KS, Lee SH. et al. Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study. Endoscopy 2013; 45 (03) 202-207
• 27 Belderbos TD, Leenders M, Moons LM, Siersema PD. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46 (05) 388-402
• 28 Thiruvengadam SS, Fung BM, Barakat MT, Tabibian JH. Endoscopic mucosal resection: best practices for gastrointestinal endoscopists. Gastroenterol Hepatol (N Y) 2022; 18 (03) 133-144
• 29 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on colorectal cancer. Gastroenterology 2020; 158 (04) 1131-1153.e5
• 30 Tate DJ, Desomer L, Klein A. et al. Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool. Gastrointest Endosc 2017; 85 (03) 647-656.e6
• 31 El Rahyel A, Abdullah N, Love E, Vemulapalli KC, Rex DK. Recurrence after endoscopic mucosal resection: Early and late incidence, treatment outcomes, and outcomes in non-overt (histologic-only) recurrence. Gastroenterology 2021; 160 (03) 949-951.e2