Partially insulated cutting instruments for hybrid endoscopic submucosal dissection - the Flat Adenoma Resection Instruments (FARIn).

The endoscopic resection of colorectal polyps that are limited to the mucosa is a well established procedure. Nevertheless, modern imaging technology and screening programs have increased the detection of benign but large (>20mm) polyps. In flat laterally spreading tumors (LST), especially the nongranular (NG) type, the rate of submucosal invasion is found to be as high as 39% (34%–44%) [1]. For this reason a resection in one piece is mandatory [2]. We report on the resection of a 25-mm flat rectal LST-NG in a60-year-oldpatientwho was admitted to the Klinikum Augsburg after screening colonoscopy (●" Fig.1). Examination with a high definition colonoscope (CF-HQ 190I; Olympus Medical Systems, Tokyo, Japan) demonstrated a SanoType II, pit pattern IIIs lesion. We decided to use two newly developed devices, the Flat Adenoma Resection Instruments (Endox-Feinmechanik GmbH, Bad Urach, Germany). Submucosal injection was performed using a mixture of saline, epinephrine (1:100000), glycerol