Episode Overview:
In this episode, host Dr. Alan Smith discusses a new hybrid endoscopic technique that combines aspects of ESD and EMR to improve resection of difficult to remove gastrointestinal lesions.

Key Topics Covered:
- Limitations of traditional endoscopic resection techniques like ESD and EMR
- Overview of the ESD-EMR hybrid technique (also called pre-cutting EMR)
- Step-by-step explanation of how the hybrid technique works
- Types of challenging GI lesions the hybrid technique is useful for
- Benefits of the ESD-EMR approach over standard resection methods
- Limitations and alternatives to the hybrid technique

Episode Highlights:
- Laterally spreading colorectal lesions often cannot be fully resected with standard EMR snares due to slippery mucosa, leading to recurrence. The ESD-EMR hybrid technique creates a pre-cut groove around the lesion that enables complete en bloc snare resection.
- Serrated polyps in the colorectum frequently evade polypectomy snares because of their subtle mucosal surfaces. The hybrid technique overcomes this with circumferential pre-cutting to allow complete snare capture. 
- For difficult to resect subepithelial tumors like lipomas, the combined ESD-EMR approach facilitates resection of larger lesions compared to standard EMR.
- The hybrid technique decreases recurrence rates and lowers perforation risks versus ESD in less experienced hands.

Notable Quotes:
"But ESD and EMR have limitations resecting certain flat, slippery lesions. Laterally spreading colorectal polyps often slip out of EMR snares, causing incomplete removal and recurrence."

"Making a customized groove around the lesion enables complete snare capture and resection of even challenging flat lesions."

"While limitations exist, this innovative ESD-EMR hybrid strategy expands the range of lesions treatable by endoscopic resection while minimizing recurrence and perforation risks."

Sources:

1. https://endocollab.com/blogs/news/the-esd-emr-hybrid-technique-for-improved-endoscopic-resection
2. https://www.thepracticingendoscopist.com/p/the-esd-emr-hybrid-or-pre-cutting

Topics mentioned:
Endoscopy, ESD, EMR, endoscopic resection, endoscopic submucosal dissection, endoscopic mucosal resection, hybrid technique, pre-cutting, GI tumors, GI lesions, laterally spreading tumors, colorectal polyps, serrated polyps, adenomas, subepithelial tumors, lipomas, en bloc resection, snare resection, electrosurgery, submucosal injection, submucosal dissection, polypectomy, recurrence prevention, non-lifting lesions, fibrotic tumors, gastroenterology

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