Improving Complete Endoscopic Mucosal Resection (EMR) of Colorectal Neoplasia

Improving Complete Endoscopic Mucosal Resection (EMR) of Colorectal Neoplasia: A Randomized Prospective Comparison of Snares and Injectate in the Resection of Large Sessile Colonic Polyps

The investigators seek to compare two techniques of removing pre-cancerous lesions from the colon. The investigators also will compare two solutions used during the procedure to determine if either solution allows for an improved removal of the tumors.

The primary aim of the study is to compare the efficacy, efficiency and safety of two types of snares used in Endoscopic Mucosal Resection (EMR), a combined needle and snare unit (ISnare, US Endoscopy) versus an oval braided snare with spiral wire (Snaremaster, Olympus). The secondary aim is to explore whether EMR efficacy and efficiency is depended upon the injection solution used, saline versus Gonak (a solution containing HPMC, saline, and epinephrine) for EMR.

Inclusion Criteria:

• Sessile colorectal polyp
• laterally spreading lesions as defined by Paris Classification type II and > 1 cm or greater

Exclusion Criteria:

• Those with ulcerated depressed lesions (Paris type III) or biopsy proven invasive carcinoma
• Inflammatory bowel disease patients
• Coagulopathy ( INR> 1.5) that cannot be corrected