ABSTRACT
E:ndoscoJJic muco•sal ~esection of rectal lesions Endoscopic muGosal resection (EMR), a technique developed by Japanese endoscopists, refers to ti·re rernoval of sessile or ·flat neoplasms confined to the mucosa. EMR is an alternative to surgical resection for the management of sessile colorectal villous adenornas, adenornas witi'r carci-
Polypectomy margin Invasion of submJcosal bowel wall Width of sut,mucosal invasion Degree of dif ferentiation
Clear or > :L mm Absent
involved by cancer Present
Tumor 'budding' Venous or lymph c;,tic invasion
Well or moderate Absent Absent
< 4 rnm Poor Present Pres ent
A Le5ions in colon: a. Pedunculated polyp with invasion into outer third of
subrnuco:;n or pedunculated lesions ~vitli tymphovascular invasion
b. Sessile lesions removed with margin <.1 mm c. Sessile lesions removed piecemeal d. Sessile lesions with depth of invasion into outer
third of submucosa e. Sessile lesions with lymphovascular invasion
B. Lesions in middle third and upper thinl ot rectum identical to A above.
