Endoscopic mucosal resection

Yeah, he's back after spectacular podcasts.

And we want to do something which is very important, surveillance colonoscopies after EMR.

You know, we recently had the podcast with Michael Brettau about his EPOS papers in the New England Journal.

which the main one focused on advanced adenomas.

Because in the first table in the supplement, the original polyps were described.

When we speak about advanced adenomas, all endoscopies have those live demo cases in mind, you know, with five centimeter large flat adenomas, ESD is done or a 45 minute, one hour EMR.

But in fact, if I look at this table in both groups, the mean polyp size was seven millimeters.

And, um, uh, There was a fair share of sessile and so on and so on.

It is.

Advanced endoscopic techniques like EMR and ESD allow gastroenterologists to peel massive flat lesions off the bowel wall.

But that technological advancement places an enormous burden on the pathologist.

They have to accurately measure that 1,000 micrometer depth to save the patient from radical leukemia when it is safe and to mandate it when it is absolutely necessary.

But if it progresses to high-grade dysplasia, observation is no longer an option.

You must intervene aggressively with endoscopic mucosal resection, or EMR, or a formal esophagectomy to preempt invasive carcinoma.

And chemical damage isn't always intrinsic, right? Eosinophilic esophagitis presents with acute food impaction, often in young men.

Yes, and the biopsy will show over 15 eosinophils per high-power field.

Scleroderma, presenting with an open fibrotic LES, carries a massive aspiration risk during anesthesia induction.

Number five, surveillance of Barrett's esophagus requires scopes every three years if no dysplasia is present.

Progression to high-greed dysplasia demands aggressive intervention via EMR or esophagectomy to halt malignant progression.

Number six, eosinophilic esophagitis, frequently presenting as an acute food impaction, requires a biopsy showing greater than 15 eosinophils per high-power field for diagnosis.