Piecemeal EMR of a laterally spreading tumor (LST)

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Steffen Hornoff, Berlin


Sequence 1 — exposure of the tumor

Diagnosis of a granular-type laterally spreading tumor at the right colic flexure.

Sequence 2 — injection under the lesion

Injection with a mixture of NaCl and toluidine blue.

Sequence 3 — excision using a polypectomy snare

Excision using the piecemeal technique with a 15-mm (monofilament) snare

Sequence 4 — continuing the excision using the polypectomy snare

Excision on the right edge of the tumor, where adjustment is difficult, and at the distal margin of the tumor. Positioning of the snare using the hypomochlion (fulcrum) technique.

Sequence 5 — continuing the excision and removing small residual pieces of adenoma

Excision of residual tumor tissue after repeated injection underneath the lesion, and excision of residual pieces of the adenoma on the right margin of the tumor.

Sequence 6 — inspection of the resection margins and closure of the resection site using clips

Demonstration of the resection margins and clip closure of the resection site with visible vessels.

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