How to 'attack' ?

This polyp was found in the sigmoid.
HOW IS IT BEST REMOVED?

■ Cold snare polypectomy

Wouldn't be my first thought!

■ EMR

I agree - single fragment EMR!

■ ESD

Would just add time and expense to procedure (unless you need practise, I guess)

explanation

​This 10-12mm polyp is covered with a beautiful gyrate crypt pattern typical of a TVA. The risk of cancer deep within, in spite of the normal surface is far below 1%. But it's not 0% and it would also be a little difficult to cut through this amount of tissue. For these reasons, I think that 'cold snaring' would be wrong. 

At the other end of the spectrum, we have an ESD. It would ensure a single fragment resection but would take about 20 minutes or so. 

The in between the two, we have an EMR. If course, a single injection of 3-4ml would lift this nicely and then a 15mm snare would resect it, single fragment, within a minute. 

I think that the best method of removal of polyps up to about 2cm, is by EMR as polyps up to this size can usually be removed as a single fragment.