Abstract
Careful assessment of the ability to remove a difficult polyp should be made prior to any attempt at polypectomy. Availability of the proper equipment and trained ancillary personnel should be confirmed prior to attempting an advanced polypectomy. Delaying the polypectomy until all resources are optimal will increase success and decrease complications. Endomucosal resection (EMR) is generally defined as the removal of a flat or sessile polyp confined to the mucosa or submucosa, usually for lesions >2 cm in size. Injection-assisted, cap-assisted and ligation-assisted techniques have been described to perform EMR. EMR is the most widely accepted method of performing advanced polypectomy. Endoscopic submucosal dissection involves dissecting the polyp off the submucosal space and is a more meticulous, time-consuming, and technically challenging method of performing advanced polypectomy.