Figure 5 Standard ESD and hybrid ESD-EMR techniques Figure 5 | Standard ESD and hybrid ESD-EMR techniques. (a–d) Standard ESD using a ball-tipped FlushKnife (Fujifilm, Japan). a | A 4 cm rectal polyp, b | Circumferential mucosal incision for lesion isolation. c | Creation of polyp flap using gravity and cap for retraction. d | Final result of en bloc excision. (e–h) Hybrid ESD–EMR using snare and SB Knife Jnr (Sumitomo Bakelite Co., Ltd, Japan). e | A 7 cm recurrent ascending colon polyp surrounded by diverticular ostia. f | Partial snare EMR resection of the polyp periphery and use of SB Knife to isolate and undermine the fibrotic part of the polyp. g | Snare engagement at the submucosal groove created by the SB Knife. h | Final result of excision. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection. Saunders, B. P. & Tsiamoulos, Z. P. (2016) Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2016.96