Large sessile polyp extending over the rectosigmoid junction. (a) This 5-cm large polyp was found in the rectosigmoid junction. (b) Prior to resection, injection with epinephrine 1 : 20 000 is performed to lift the polyp from the muscle layer. (c) Initial piecemeal resection of small portions is performed to avoid perforation. (d) The exposed muscle layer will serve as a point of orientation for further resection. (e) Remaining parts of polyp behind the fold are removed using the fulcrum technique. Tangential orientation of the snare to the muscle layer allows for safe ensnaring. (f) Minute remnants of adenomatous tissue can be removed by APC.
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This image is taken from U. Seitz, S. Bohnacker, S. Seewald, F. Thonke, N. Soehendra & J. Waye. Chapter 4, In Colonscopy, Advanced Digestive Endoscopy e-books. GastroHep.com.
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