'Fish-eye' polypectomy defect: a new sign during endoscopic mucosal resection?

A 75-year-old man was referred for the endoscopic management of an 80 mm large non-pedunculated colorectal polyp (LNPCP) in the sigmoid colon. The lesion was evaluated under white-light (figure 1A), narrow-band imaging and near-focus. Granular nodular-mixed type morphology was identified with a homogeneous surface pattern (Kudo IV, Japan NBI Expert Team IIA) consistent with benign adenomatous histopathology. Figure 1 80mm large non-pedunculated colorectal polyp (LNPCP) in the sigmoid colon. Piecemeal endoscopic mucosal resection was performed (figure 1A,B). After successful resection of the first specimen, defect evaluation revealed a hole within a white cautery ring, most consistent with a perforation without contamination (sydney deep mural injury (DMI) classification type IV1; figure 1D). A viscous amorphous …