A Hematoma Caused By An Excessively Superficial Injection: Go Under The Red Bleb!

Effective submucosal injection is key for efficient and safe endoscopic resection, such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Deep injection into the muscularis propria is dangerous and may result in a false non-lifting sign. A too superficial injection in the muscularis mucosae is a classic issue, associated with rapid poor lifting and a hematoma of the muscularis mucosa caused by injury to the extensive vascularization. Such a situation complicates many endoscopic resections [1]. During EMR, the scenario may compromise technical success because the lesion is not lifted. During ESD, the difficulty increases because of major bleeding and loss of the dissection plan.