Abstract
Conventional endoscopic mucosal resection (EMR) is a widely used technique in the treatment of colorectal tumors. When resecting laterally spreading tumors (LSTs) with conventional EMR, the distal edge is difficult to dissect and tends to be piecemealed. However, the nongranular pseudodepressed type (LST-NG-PD) has a high risk of malignancy, requiring en bloc resection [1]. Endoscopic submucosal dissection (ESD) can ensure high en bloc resection rates, but it also has drawbacks such as high perforation rates, high cost, and long procedure times. Binmoeller et al. introduced underwater EMR (UEMR) as a useful alternative to ESD for LSTs [2]; however, treating the distal end remains a challenge and could cause segmental resection. In addition, the use of water in UEMR may impair clarity of view if bleeding occurs. Partial submucosal injection improves visualization of the distal edge [3], and gel immersion improves the endoscopic visual field [4] [5]. Here, we report that under-gel EMR with partial submucosal injection is an effective means of achieving en bloc resection of LST-NG-PD ([Video 1]).
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