A second chance at EMR: the avulsion technique to complete resection within areas of submucosal fibrosis

Abstract

We describe a case of a large rectal adenoma that had extensive central submucosal fibrosis resulting from a previous attempt at EMR at another institution. Despite the presence of a nonlifting sign, the avulsion technique with standard hot biopsy forceps and Endocut electrocautery was used to resect the fibrosed area successfully, with no evidence of recurrence at follow-up (Fig. 1; Video 1, available online at www.giejournal.org).