Large polyps: Pearls for the referring and receiving endoscopist

Figure 3 Endoscopic mucosal resection complicated by prior endoscopic tattooing. A and B: Presence of previously placed tattoo ink proximal and lateral to a large (25 mm) sessile polyp, suggestive of injection being made too close to (or under) the polyp and/or an excess volume of ink injected; C: Suboptimal lifting after 10 cc of saline and 13 cc of submucosal injectable composition as a result of submucosal fibrosis from the prior tattoo, complicating en bloc endoscopic mucosal resection; D, E and F: Tattoo ink and associated tissue fibrosis can be seen infiltrating the submucosa directly under the polyp.