Solutions for submucosal injection: What to choose and how to do it

Figure 1 Decision algorithm. ¹Without deep submucosal invasion features; ²In most cases, especially in the right colon, deep thermal injury with hot snare polipectomy is a potential risk; ³Clip placement can be an alternative to submucosal injection; ⁴Hyaluronic acid should be avoided in piecemeal resection; ⁵Endoscopic submucosal resection enables en-bloc resection of larger lesions; ⁶May be considered in Paris 0-IIa gastric Lesions < 15 mm. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; NS: Normal saline; LST: Lateral spreading tumour.

Figure 2 Submucosal injection for en-bloc resection of a colonic flat lesion.

Figure 3 Submucosal injection for a piecemeal resection of a colonic flat lesion.

Figure 4 How to inject: Pratical tips. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal resection.