Endoscopic mucosal resection or endoscopic submucosal dissection: choosing the right tool to a polyp-free colon.

PURPOSE OF REVIEW: Endoscopic resection is now the standard of care for the management of colorectal polyps. With increased training and expertise in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), it is important to recognize their complementary roles, as well as their individual strengths and limitations.

RECENT FINDINGS: Here, we draw upon the experience of a real patient scenario to provide a case-based review on EMR and ESD. We will review evidence-based technical refinements to EMR which have improved procedural safety and decreased recurrence rates, as well as how expanded access to ESD and enhanced training has resulted in improvements in outcomes and adverse events. Finally, we will discuss how lesion, patient, and endoscopist factors influence the overall endoscopic resection strategy.

SUMMARY: EMR and ESD are complementary tools in the modern endoscopic resection toolkit, and the correct resection strategy draws upon a deep understanding of the tools available and is individualized based upon patient, endoscopist, and lesion characteristics.