- Inject beneath the lesion to lift it and separate it from the muscularis propria.
- Use a needle to inject a solution, typically saline or a mixture with epinephrine (to reduce bleeding) and a dye like methylene blue or indigo carmine (to visualize the lift).
- Ensure an adequate and uniform submucosal cushion is created (“the lift”).
- Resection
- Snaring:
- Use a snare to encircle the lesion.
- Position the snare around the elevated lesion and close it gently to capture the base of the lesion.
- Electrocautery:
- Apply electrocautery energy to cut and cauterize simultaneously. Settings depend on lesion location and equipment.
- Resect in piecemeal fashion for larger lesions (piecemeal EMR) or en bloc for smaller lesions.