Comparison of Methods for Removing Large Benign Broad-based Epithelial Neoplasms of the Colon: ESD and EMR.

"3-4 ml of high-osmolar solution or saline solution stained with indigo carmine are introduced into the submucosal layer under the formation. The formation and the surrounding mucous membrane (at least 5 mm from the edge of the formation) are removed using a standard diathermic polypectomy loop available to the operator. The formation is removed using electric current in the EndocatQ mode. After the formation is removed, the resection site is examined in white light, then virtual chromoscopy (NBI), and then examined with magnification. If residual tissue of the formation is detected, it is removed using the same technique. If the removal of residual tissue of the formation was performed by another method, indicate which one and why.~The removed formation is extracted using a snare loop; if it is removed in parts, then all fragments, if possible, are extracted through the aspiration channel of the endoscope; for large fragments, a snare loop is used."

After assessing the boundaries of the formation, a mark is made at least 5 mm from the edge, then a circular or semicircular incision of the mucosa is made, after which the formation is removed by dissection of the submucosal layer using a scarecrow knife, a knife with a ceramic head at the end in EndocutQ mode, spray-coag swift-coag. The EDPS technique - a tunnel method, will also be used where feasible. The essence of the technique is a semilunar incision of the mucous membrane, retreating from the marks, and creating a tunnel under the formation to the proximal edge of the marks, with subsequent cutting off of the formation along the edges. The removed neoplasm is extracted and stretched on a plate. After removal, the edges and bottom of the wound are assessed, if necessary, prophylactic coagulation of visible vessels and clipping are performed.