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During endoscopic mucosal resection (EMR), snare resection is preferred for all portions of lateral spreading tumors. When very flat tissue cannot be snared, options include ablation (most often performed with argon plasma coagulation [APC]) and hot forceps avulsion. Avulsion is performed by grasping the residual flat tissue with hot forceps, applying mechanical tension, and then pulling the tissue off while applying electrocautery.
In a retrospective analysis of 223 resected lesions measuring ≥20 mm, recurrence rates at follow-up were 4.2% with en bloc EMR; 3.0% with piecemeal EMR and complete snare removal; 59.3% with piecemeal EMR and APC of visible residual neoplasia; and 10.3% with piecemeal EMR with avulsion.