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Background: Endoscopic management of the nonlifting areas of a colonic polyp is a significant challenge. The traditional approach has been to use ablative techniques with mixed long-term results., Objective: To evaluate the safety and efficacy of hot avulsion (HA), a modification in the use of hot biopsy forceps in the management of the nonlifting areas of a colonic polyp., Design: Retrospective review of data from a prospectively maintained colonic Endoscopic Mucosal Resection database., Setting: Tertiary referral hospital., Patients and Intervention: Twenty patients in whom HA was used as part of the polypectomy technique., Main Outcome Measurements: Location and size of polyp, reasons for nonlifting, immediate success, residual rates, and adverse events., Results: In our 20 patients studied, the main reasons for nonlifting were scarring from previous EMR attempts in 55% and scarring from previous biopsy in 35%. Mean size of avulsion was 4.4 mm (range, 1-15 mm). At the index procedure, HA was successful in removing macroscopic adenomatous tissue in all patients. At follow-up examinations, 85% (17/20) had no macroscopic or microscopic neoplasia residual and 15% (3/20) had a small area of residual that was easily treated with repeat HA. There were no immediate or long-term adverse events., Limitations: Nonrandomized, single-center experience., Conclusions: HA appears to be a safe and effective adjunct treatment to snare polypectomy for nonlifting areas of a colonic polyp. Further randomized multicenter studies are required with direct comparison to established techniques., (Copyright © 2014. Published by Elsevier Inc.)