What is the significance of the Purple trial in the field of endoscopy, particularly for advanced colonoscopists and providers of Endoscopic Submucosal Dissection (ESD), Endoscopic Mucosal Resection (EMR), and Peroral Endoscopic Myotomy (POEM)?

From the Guidelines

To prepare for your 30-minute endoscopy journal club presentation, I strongly recommend focusing on the recent advances in Endoscopic Submucosal Dissection (ESD) for colorectal lesions, as highlighted in the 2024 NCCN guidelines 1. This approach has shown promising results in terms of curative resection rates, en bloc resection rates, and reduced adverse events, making it an ideal topic for discussion among ESD/EMR/POEM providers. When structuring your presentation, consider allocating 10 minutes for background and methodology, 10 minutes for results and clinical implications, and 10 minutes for discussion and questions. Some key points to cover include:

• The technical aspects of ESD, such as optimal injection solutions and equipment selections
• Procedural refinements, including the pocket-creation method for colorectal ESD
• Pre-procedure assessment protocols and post-procedure management, including specific antibiotic regimens when indicated
• The impact of ESD on important outcomes like en bloc resection rates, R0 resection rates, procedure time, and adverse events, as reported in recent studies 1
• Comparison of ESD with other techniques, such as transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS), and their respective outcomes Including your own challenging cases can stimulate discussion among your expert colleagues and provide valuable insights into the real-world application of advanced endoscopic techniques. As noted in the 2020 US multi-society task force on colorectal cancer recommendations 1, EMR is a preferred treatment method for large non-pedunculated colorectal lesions, but ESD offers higher rates of curative resection and more accurate pathologic assessment, making it a valuable technique to discuss in the context of recent advances. By focusing on ESD and its applications, you can provide a comprehensive and engaging presentation that highlights the latest developments in endoscopic detection and resection techniques for colorectal lesions.

From the Research

Presentation Overview

To prepare for your 30-minute presentation at the endoscopy journal club, we will focus on key points related to ESD, EMR, and POEM procedures, highlighting their safety, efficacy, and potential complications.

ESD and EMR Procedures

• ESD and EMR are commonly performed procedures for the removal of gastrointestinal lesions [@\1@, @\5@].
• A key challenge in these procedures is the risk of post-procedure stenosis or electrocoagulation syndrome [@\1@, @\4@].
• The use of prophylactic antibiotics has been shown to reduce the risk of electrocoagulation syndrome after colorectal ESD [@\4@].
• Sclerotherapy needle injections can create a stable mucosal lift, which is essential for ESD and EMR procedures, but careful scrutiny of the lift is necessary to avoid complications [@\5@].

POEM Procedure

• POEM is a procedure used to treat esophageal motor disorders, and its safety and efficacy have been evaluated in several studies [@\2@].
• The use of antibiotic prophylaxis in POEM has been associated with an increased risk of adverse events, but it does not impact the effectiveness of the procedure [@\2@].
• A liquid diet before the POEM procedure has been shown to reduce the risk of adverse events [@\2@].

Clinical Trials and Evidence-Based Practice

• Clinical trials are essential for evaluating the safety and efficacy of new medical interventions, including endoscopic procedures [@\3@].
• Pragmatic clinical trials can provide valuable insights into the real-world effectiveness of interventions and can help to address health disparities [@\3@].
• The results of clinical trials should be carefully considered when developing guidelines and recommendations for endoscopic procedures [@\3@].

Key Takeaways for Your Presentation

• Emphasize the importance of careful patient selection and preparation for ESD, EMR, and POEM procedures.
• Discuss the potential complications of these procedures and the strategies for mitigating them.
• Highlight the latest evidence on the use of prophylactic antibiotics and other interventions to improve outcomes.
• Consider the implications of clinical trials and evidence-based practice for the field of endoscopy.