Cold snare polypectomy (CSP) is becoming one of the therapeutic methods of choice for benign polyps in light of its time- and cost-effective properties compared with hot snare polypectomy. 1 The safety and effectiveness of piecemeal CSP (pCSP) of large sessile serrated lesions (SSLs) have been studied in the past, 2,3 and we have reported pCSP for SSLs without using injection. 4 The method was effective, but minor bleeding around the edge of the SSL often rendered examination for remnant tumors more difficult. To overcome this problem, we have used acetic acid spray (AAS) to make tumors more clearly distinguishable from the surrounding mucosa. AAS has been previously reported to cause an aceto-whitening reac- tion when used on SSLs, such as sessile serrated ade- nomas/polyps (SSA/Ps); when combined with narrow- band imaging (NBI), it becomes an effective tool in iden- tifying polyps and their margins.
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