Editing Colonoscopy technique (section)

=== Endoscopic mucosal resection (EMR) ===

* Define margins clearly and estimate size and degree of invasion
* Raise a submucosal cushion with fluid to allow excision of more tissue, also acts as thermal cushion. Start with the proximal side, as this can be hard to reach once the distal side is lifted.
* Failure to lift raises concern for malignancy (unless a previous polypectomy attempt could have fixed it to the submucosa)
* Usually use Gelofusine mixed with methylene blue and maybe also adrenaline
* Use hot snare to resect
* Polyps >2cm should be resected piecemeal to reduce the perforation rate
* Must tattoo - preferably at least 3cm away on the opposite wall, since if it spreads to the polypectomy site, subsequent identification of recurrence will be harder