Tip-in EMR Compared With ESD for 20- to 30-mm Nonpedunculated Colorectal Neoplasms

Tip-in endoscopic mucosal resection (EMR) involves submucosal injection, followed by an incision on the proximal side of the injection mound using a snare tip with cutting current. The snare tip is then anchored in that incision, and the snare is opened over the lesion with slightly forward pressure to expand the snare diameter. 

The tip-in EMR technique was compared with endoscopic submucosal dissection (ESD) using propensity score matching. Among 709 lesions, 140 were removed by tip-in EMR and, using multiple factors, matched with 140 lesions removed by ESD. The primary outcome was the R0 resection rate, which was higher with ESD than with tip-in EMR (90.7% vs 62.9%). En bloc resection was also higher with ESD at 99.3% versus 85% using tip-in EMR. Procedure time was shorter in the tip-in EMR group at 8 minutes versus 60 minutes with ESD. Recurrence rates were similar at 2.1% for tip-in EMR and 0% for ESD.