Piecemeal EMR of a laterally spreading tumor (LST)

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

Injection with a mixture of NaCl and toluidine blue.

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

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.

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