Learning points summary from Dr. Silvia Sanduleanu, University Hospital Maastricht, Netherlands
1. LSTs granular homogeneous are common - they account for 1/3 of all LSTs and have the lowest risk to contain SMI is low - less than 1 in 100. Piecemeal endoscopic resection is the best therapeutic approach for LST-G-H. Benign polyps: endoscopic resection is the best approach.
2. We should plan sufficient time to ensure complete resection of the lesion is achieved in the same session. Never attempt resection, then stop halfway. Partial resection leads to fibrosis and tethering with increased technical difficulty for subsequent resections and risk of perforation. Incomplete resection makes future resections technically challenging and lengthy.
3. Endoscopic resection of residual adenomas is possible! It requires a careful and meticulous approach, discipline, and patience.
4. Inject-and-cut is recommended in such cases to prevent a recurrence. Hot avulsion should be only employed as a last resort. Hot biopsy avulsion helps in resecting tethered areas when the area is small
5. Roy would add that DELIBERATE PRACTICE with feedback is the only way to achieve Mastery Learning in endoscopic resection.
6. Close follow-up is critical.
