The novel EMR+ technique uses an external additional working channel (AWC®) allowing for tissue retraction and triangulation. This pilot study describes the early safety and efficacy data from the first 6 in human clinical cases. En-bloc resection and R0-status was achieved in all patients, no severe adverse events occurred.
A. Sportes et al., Department of Gastroenterology, Institut Arnault Tzanck, Saint Laurent du Var, France, presented a pilot study evaluating the first use of the novel EMR+ technique in humans. EMR+ is a grasp and snare technique utilizing an over the scope additional working channel (AWC, Ovesco Endoscopy), which allows the introduction of an additional grasping tool for traction or counter-traction. Positioning of the AWC can be customized to the clinical scenario, depending on the position of the lesion and optimal angle of exit for the second tool. Thereby EMR+ allows for en-bloc resection of mucosal lesions ≥ 2 cm suspected of harboring high-grade dysplasia or early adenocarcinoma.
EMR+ was performed in 6 patients in 2 endoscopy centers (University Hospital of Goettingen, Germany and Institut Arnault Tzanck, Saint Laurent du Var, France) for lesions of the upper (n = 2) and lower (n = 4) gastrointestinal tract. The median age of the patients was 76 years, 3 patients were male, 3 female. The average estimated lesion size was 30.8 mm. Mean procedure time was 25.5 min. All resections were technically successful (en-bloc resection confirmed by endoscopist) and clinically successful (histologically confirmed R0-status in all cases). No severe adverse events such as major bleeding or perforation occurred in any of the procedures. In 2 cases, there was intra-procedural minor bleeding which could be managed via a hemoclip application. There were no post-interventional adverse events. During a follow-up of 6 months no further endoscopic or surgical treatment was subsequently needed.
The authors concluded that the EMR+ technique showed a good safety and efficacy profile in this pilot study. The technique may offer an alternative to available techniques to remove complex, large mucosal-based lesions in the GI tract.
Novel modified endoscopic mucosal resection of large GI lesions (> 20 mm) using an external working channel (AWC) may improve R0 resection rate: initial clinical experience
Sportes A, Jung CFM, Gromski MA, Koehler P, Seif Amir Hosseini A, Kauffmann P, Ellenrieder V, Wedi E..
BMC Gastroenterology 2020; 20:195. https://doi.org/10.1186/s12876-020-01344-6