Endoscopic mucosal resection in the West. A technique looking for an indication

Endoscopic mucosal resection (EMR) is a major advance in the management of various lesions of the gastrointestinal tract. Although a product of the East and the West, it has been more widely used in the East, particularly in Japan and China. Western endoscopists have remained reluctant to apply EMR for various reasons. The incidence of both benign and malignant gastrointestinal lesions in the American-European population can differ considerably compared with the Asian population. Furthermore, western endoscopists have had less exposure to this technique and may be less enthusiastic to perform a more invasive and risky procedure. This article addresses the worldwide use of EMR and discusses its potential indications. Reasons why EMR is not widely used in the West are summarized and means to improve its widespread application are suggested.