LAUSR

Figure 2. No vessels, and the regular white spot distribution is seen with magnifying narrow-band imaging. Cold snare polypectomy (CSP) has become a common treatment for small polyps, but a size limitation exists because some lesions are insufficient for precise histologic examinations. If the lesion measures 10 mm or more, its possibility of having malignant potential increases; this is the reason why the limitation exists for CSP. Although sessile serrated lesions (SSLs) are important precursors of colorectal cancer, it is not known whether treatment is safer and more effective particularly for large SSLs ( 10 mm). As is already known, an SSL has a low risk of containing a malignant component even when it exceeds 10 mm. The duration of CSP without injection is short compared with the duration of endoscopic submucosal dissection of larger SSLs. Furthermore, the duration of CSP procedures is shorter than that of EMR, which requires injection and clipping after resection. A large SSL ( 20 mm), which could be a good candidate for CSP, has the disadvantage of precise histopathologic evaluation quality. Regarding lesions exceeding 10 mm, Tutticci and Hewett reported on use of the piecemeal cold snare EMR technique. The technique requires 2 steps: repeated