Large Transverse Colon Polyp - EMR in a patient MYH-associated polyposis

Problem: Multiple polyps in a woman with MYH-associated polyposis who was recommended to undergo colectomy. She preferred to get the large polyp removed to buy time, despite the recommendation to undergo surgery as she could not take time out for surgery.
Polyp: Large polyp occupying nearly 40% of circumference. Notice tattoo mark close to the polyp (one should avoid it as this causes scarring and makes resection technically difficult).
Piecemeal EMR: Sequential injection of dilute Indigo Carmine followed by snare resection. Small central tethered area was biopsied and submitted in a separate jar; rest of the polyp in a different jar. Closure was hard due to scarring from prior tattoo injection into the base of the polyp and large size of resection.
Plan: Recommend surgery