Post written by Yoshiaki Kimoto, MD, from the Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

A flat and fold-over 25-mm lesion covered with rich mucus was pointed out at the ascending colon. We diagnosed the lesion as SSL without dysplasia. Using a 10-mm oval-type snare (SnareMaster Plus; Olympus, Tokyo, Japan), the near side of the lesion was tied up and cut without electric current. We repeated the same process in the foreground to background. In total, 3 piecemeal resections were done and endoscopic complete resections were archived without any adverse events. We sampled 4 negative biopsies of the margins for neoplastic tissue. Histopathological examination showed SSL without dysplasia and biopsies were negative. Follow-up colonoscopy after 6 months had no residual or recurrent serrated tissue.

Sessile serrated lesions (SSLs) have quite a low risk of the malignancy even if the sizes became larger than 10 mm, so piecemeal cold snare polypectomy (pCSP) could be a safe and acceptable treatment option. In previous reports, the piecemeal cold snare endoscopic mucosal resection (pCS-EMR) techniques required 2 steps, injection and cold snaring repeatedly. We adopted a simple 1-step method: pCSP without submucosal injection. Because no injection needles or solution are needed, this method is more cost-effective and shorter than pCS-EMR.

As a result, we were able to resect even this fold-over lesion by using pCSP without submucosal injection. Needless of the injection needle (NeedleMaster; Olympus, Tokyo, Japan) (50 USD), this method is more cost-effective comparing pCS-EMR. Furthermore, the duration of pCSP procedures was shorter than the duration of EMR, which requires injection and clipping after the resection. pCSP without submucosal injection is an effective and economical method for resecting a large SSL. Furthermore, we could assess this method prospectively.

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