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As part of an Australian study of endoscopic mucosal resection (EMR) of laterally spreading lesions ≥20 mm in size, researchers retrospectively described some 900 lesions in 800 patients with regard to the incidence of deep mural injury (DMI).
In their proposed Sydney classification system, type 0 is a normal post-EMR blue-stained submucosa. Type 1 is when the muscularis propria is visible but not injured. Type 2 is focal loss of the submucosal plane, typically caused by submucosal fibrosis, creating difficulty in evaluating the muscle. Type 3 is a nonperforated target sign, type 4 is perforated without contamination, and type 5 is perforated with contamination. Type 3–5 DMI must be closed promptly with hemostatic clips.
The incidence of type…