Curriculum for training in endoscopic mucosal resection in the colon

Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Tate D, Argenziano ME, Anderson J, et al.

Endoscopic mucosal resection (EMR) was first referred to by Dehyle in 1973 as a technique to remove rectal polyps transanally [1] and later, in Japan, as a method for removing early gastric cancer [2]. It describes any diathermic resection of a gastrointestinal (GI) lesion using a snare with prior submucosal injection [3, 4] (hot snare EMR). Over the years this definition was broadened to involve polyp resections that did not require electrosurgical energy (cold snare EMR) [5].

EMR is the preferred technique to remove flat and sessile ≥ 10-mm polyps in the colon. It is safe and effective [4, 6], with significantly lower cost [7], morbidity, and mortality [8] compared with surgical resection. In expert hands, more than 98 % of colorectal polyps can be removed completely using EMR [4, 6, 9, 10], without resorting to more resource-intensive endoscopic [11, 12] or surgical techniques.

Despite its widespread applicability, training in EMR is often experiential, unstructured, and dependent on trainers without conscious competence in the technique [13]. Compounding this, there is no curriculum for how to train in the procedure and differing published best practice advice on how to perform high quality procedures.