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 techniqueEpisode 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:https://endocollab.com/blogs/news/the-esd-emr-hybrid-technique-for-improved-endoscopic-resectionhttps://www.thepracticingendoscopist.com/p/the-esd-emr-hybrid-or-pre-cuttingTopics 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