Large Sessile Serrated Polyps Can Be Safely and Effectively Removed by Endoscopic Mucosal Resection  Aarti K. Rao, Roy Soetikno, Gottumukkala S. Raju, Phillip Lum, Robert V. Rouse, Tohru Sato, Diane Titzer-Schwarzl, James Aisenberg, Tonya Kaltenbach  Clinical Gastroenterology and Hepatology  Volume 14, Issue 4, Pages 568-574 (April 2016) DOI: 10.1016/j.cgh.2015.10.013 Copyright © 2016 AGA Institute Terms and Conditions

Figure 1 Endoscopic mucosal resection. (A) Identify the lesion initially with white light, then enhance visualization with narrow-band imaging followed by 0.2% diluted indigo carmine sprayed on the area of interest by a syringe through the accessory channel. (B) Inject diluted indigo carmine into the submucosal space with a 25-gauge sclerotherapy needle to create a submucosal bleb. (C) Suction air to collapse the distended colon and place the stiff electrosurgical snare around the lifted area of interest to complete resection. (D) Immediately reassess the post-resection margin for residual and use argon plasma coagulation for residual or endoscopic clips to close mucosal defects as appropriate. Clinical Gastroenterology and Hepatology 2016 14, 568-574DOI: (10.1016/j.cgh.2015.10.013) Copyright © 2016 AGA Institute Terms and Conditions

Figure 2 Patient flow chart. Clinical Gastroenterology and Hepatology 2016 14, 568-574DOI: (10.1016/j.cgh.2015.10.013) Copyright © 2016 AGA Institute Terms and Conditions