P-EMR for a Transverse Colon NG-LST Measuring 20 x 40 mm

P-EMR for a transverse colon NG-LST measuring 20 x 40 mm Avoid biopsy if no suspicious area is detected.

A 76-year-old patient presented with three LSTs located in the cecum, right colon, and transverse colon. Here, we share the video of the P-EMR procedure performed for the NG-LST in the transverse colon. A careful inspection revealed no suspicious areas but identified scarring from a previous biopsy. P-EMR was selected as the treatment method due to its faster execution compared to ESD. The site of the prior biopsy was resected with some difficulty. Coagulation of all small vessels was achieved using the coag grasper. The procedure was performed using the Olympus CF-HQ1100 DI colonoscop the X1 series, the cap being mandatory. CO2 insufflation was utilized throughout the procedure. Both a 10 mm and a 15 mm hot snare were employed during the resection. 

The total procedure time for all polyps was 150 minutes, with 35 minutes dedicated to this specific polyp.

LST are subclassified into:

Granular (LST-G): Homogenous or nodular surface.

Non-granular (LST-NG): Smooth, flat appearance (higher risk of submucosal invasion)

Piecemeal EMR Indication: Preferred for large (>20 mm) benign LSTs where en bloc resection is difficult. Lesions with low suspicion of deep submucosal invasion (Kudo pit pattern I-III, no depressed areas). 

Scar assessment: Follow-up colonoscopy in 3–6 months to check for recurrence.

Histopathology review: Confirm complete resection (R0 if margins clear).

Post-EMR Surveillance:

Complications: Bleeding (immediate/delayed), Perforation (rare but higher risk in piecemeal EMR).Why Piecemeal EMR for Transverse Colon LST?The transverse colon’s thin wall and mobility increase perforation risk; piecemeal EMR reduces tension.LST-G types are often amenable to piecemeal resection, while LST-NG may require endoscopic submucosal dissection (ESD) if high-grade dysplasia is suspected.