For sessile polyps larger than 2 cm in the colon or duodenum and almost any sized sessile polyp or early cancer in certain anatomic locations, such as the esophagus or stomach, a different set of techniques has been developed, collectively known as EMR. Although there are many technical variations and accessories, the principle of EMR is the same for all. The lesion is lifted or separated from the underlying submucosa before resection is performed either by physical traction or by injecting fluid. One technique employs a two-channel endoscope to lift the lesion first with a grasping device, such as a biopsy forceps passed through one channel of the endoscope, over which is placed a snare, passed through the second channel, to complete the removal. This method, however, has never gained popularity in the United States. A second technique, originally developed in Japan, employs a transparent cap fitted to the tip of an endoscope into which, after submucosal injection of fluid, the lesion is aspirated, and a specially designed ultra-flexible snare placed around the "pseudopolyp" so created. Suction is then released and the polyp resected using the same electrocautery settings as for standard polypectomy (Plates 36 and 37). This method is particularly applicable in the esophagus, stomach, and rectum but is rarely used elsewhere in the gastrointestinal tract.