Resection of a large recurrent laterally-spreading tumor with extended cold piecemeal endoscopic mucosal resection (p-EMR) and endoscopic full-thickness resection (EFTR)

Text Post-polypectomy surveillance colonoscopy on a 73-year-old man revealed a 35mm recurrent LST(Paris IIa+IIc,NICE type2,Kudo IIIL)on a scarred,previously tattooed area at the hepatic flexure.Given the severe fibrosis in the central area, ESD would have been difficult,at high-risk of adverse events (AEs). We performed hybrid resection(HR)with extendedcold piecemeal EMR (p-EMR) of the peripheral area and full-thickness resection (EFTR) of the central, depressed, non-lifting area, without AEs. Histology:tubulovillous adenoma with high-grade dysplasia.