Endoscopic mucosal resection for colon cancer

In recent years, with the discovery of more and more small early colon cancers, the application of endoscopic mucosal resection (EMR) has become more and more widespread. EMR was originally a diagnostic method, known as mucosal biopsy, and was later used to treat early gastric cancer, early esophageal cancer, and early colon cancer. It is an endoscopic resection method for superficial and broad-based tumors of the digestive tract. However, its indications vary depending on the equipment and operator.

Theoretically, patients with early-stage colon cancer without lymph node metastasis, shallow invasion depth, and complete resection by EMR are all suitable for EMR. However, in actual clinical application, there is still controversy over the criteria for accurate and operable EMR. Currently, EMR is generally suitable for surface lesions, especially flat and depressed lesions; when LST is difficult to perform snare resection; carcinoid and submucosal tumors, etc.

The order of EMR treatment for colon cancer is:

① Lesion confirmation

② Locally inject normal saline under the lesion mucosa to make the lesion bulge at the top

③The snare is inserted into the raised part

④ Use the forceps to lift the lesion

⑤ Remove the lesion specimen.

In addition to simple submucosal injection of normal saline, adrenaline-saline can also be injected during the treatment. Normal saline can thicken the submucosal layer, reduce the coagulative damage of the deep tissue to the electric current and prevent perforation. Adrenaline-saline can prevent immediate and delayed bleeding after surgery.