Gut Check on Gastroenterology Archive

Endoscopic mucosal resection (EMR) has become an indispensable part of the therapeutic endoscopy armamentarium. However, the technique varies from endoscopist to endoscopist — including differences in volume used, solution ingredients, and snare type.

In my institution, the three of us who do the most EMR all differ in our approaches in many respects, including choice of snare and solution make-up. For instance, for EMR lifts, I use 18 cc of saline combined with 2 cc or 1:10,000 epinephrine (for a 1:100,000 final concentration) along with 2 drops of indigo carmine as my solution. My colleagues use differing amounts of saline, epinephrine, and indigo carmine or substitute methylene blue. I use a large hex snare in most cases; one of my colleagues prefers an oval snare.

Given the variation in the solutions and snare used for EMR in my unit, I am curious as to what others are doing. Specifically…

• What is your preferred solution for EMR?

• What volume do you typically use for colon polyps?

• What snare do you prefer?

• Any other pearls for others who do EMR?