Technique for fine adjustment of snare size during endoscopic mucosal resection by a single endoscopist.

Abstract

Performing endoscopic mucosal resection for polyps located in the hepatic flexure is always challenging. The two most important reasons that make removing polyps in the hepatic flexure difficult are the instability of the position of the endoscope and the difficulty in advancing the endoscope’s accessories while in that bent angle. To overcome the instability of the endoscopic position, the left pinkie maneuver can be applied [1]. The cases shown here demonstrate that an “open-and-retract maneuver of the snare” could solve the approach problem ([Video 1]).