LAUSR

resection (C-EMR) was launched as a procedure of choice for the treatment of nonpedunculated colorectal polyps; however, for lesions of > 20mm, piecemeal EMR has been associated with significant incomplete resection rates. The sequence from incomplete resection to colon cancer is well documented in the literature. Therefore, techniques that increase the rate of en bloc R0 resection with EMR are of the utmost importance. To this end, modified EMR techniques such as precutting EMR or anchoring EMR (A-EMR) have been proposed. A-EMR was first described in the last decade [1, 2], but what is this technique and what is its merit? A small incision is created with the tip of the snare in the submucosa of the mucosal area surrounding the polyp. Subsequently, the snare tip is anchored in the defect, with the aim of both preventing slippage of the snare and widening the diameter of the open snare. So, what is already known about this technique? A multicenter French retrospective study [3] evaluating 141 sessile or flat lesions of 10–30mm showed that the A-EMR technique was very effective for lesions of 10–20mm. For lesions of <20mm specifically, the en bloc R0 resection was 82.8%; however, the proportions of en bloc R0 resection were lower for larger lesions, reaching only 50% for lesions of > 30mm. Complete transmural perforation was observed in three out of 141 cases, all of which were treated endoscopically. It is worth noting that no perforations occurred with lesions of < 20mm. Data arising from this study are promising, indicating that A-EMR might be considered as a valuable alternative to endoscopic submucosal dissection (ESD).