Single centre experience of EMR

Background and Aim: Endoscopic mucosal resection (EMR) is a specialised technique for resection of precancerous large polyps and flat lesions. In Hospital Kuala Lumpur, this service has been continued despite the Covid pandemic as these lesions are high risk for malignant change. Methods: Endoscopy reports, histopathology reports (HPE) and case files of patients who underwent EMR from September 2019 to April 2021 (20 months) were retrospectively reviewed. A total of 23 procedures were reviewed. Results: Median size of lesion was 25 mm (range 15 to 90 mm). 10 cases (43.5%) were right sided colonic lesions and 13 cases (56.5%) were left sided lesion. 10 cases (43.5%) were documented as Paris Is lesion, 7 (30.4%) as Paris Ips, 1 (4.3%) as Paris Ip, 1 (4.3%) as Paris IIa and 4 (17.4%) as LST-G (lateral spreading tumor-granular). En bloc resection was done for 21 cases (91.3%). Piecemeal resection was done for 2 cases (8.7%). Tubular adenoma with low grade dysplasia was the most common HPE findings with 8 cases (34.7%). 5 cases (21.7%) were reported as tubular adenoma with high grade dysplasia, 2 (8.7%) as sessile serrated adenomas with dysplasia, 4 (17.4%) as tubulo-villous adenoma with low grade dysplasia and 1 (4.3%) hyperplastic polyp. 3 (13.0%) patients had adenocarcinoma and all 3 had clear margins of resection. Deep mural injury (Sydney classification) occurred in 4 cases (17.4%);2 in DMI class I, one each in class II and III. All had endoscopic treatment immediately with successful outcome. None of the cases had clinically significant bleeding or perforation. There was recurrence for 1 patient and had successful endoscopic treatment. Conclusion: Our experience shows EMR is safe and an effective modality for treatment of advanced polyps.