August 14th, 2014

EMR: What Is Your Solution?

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?


3 Responses to “EMR: What Is Your Solution?”

  1. vikrant says:

    I use the same concentration of epinephrine in gelo along with methylene blue. I believe gelo is absorbed slowly so you get more time for the procedure. I use hex snares.

  2. Paul Conley says:

    I prefer hespan over saline. 3cc indigo carmine in 500cc bag of hespan. I use either an I snare with a hex shape or a stiff oval snare. I do not use epi I will clip large defects for hemostasis.

  3. Pedro Monsanto says:

    Saline combined with epinephrine (for a 1:100,000 final concentration) along with methylene blue.

    Variable volume acording with the lesions.

    Oval snare. Duble filament in some circumstances.

    Perls: I use a cap in some circumstances.

Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD


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