The "double string" sign: a warning image after cold endoscopic mucosal resection.

After snare closure, moderate traction of the snare sheath was applied to remove the lesion; however, the lesion remained trapped due to a large amount of tissue caught. On inspection of the mucosal defect, the submucosal layer was observed with apparent "bubble sign" after waterjet irrigation (Fig. The use of specifically designed snares for cold snare polypectomy with greater excision ability (without the need for traction of the snare sheath) [1] and tissue resections < 15 mm could decrease the risk of injury to the muscular layer during cold-EMR. [Extracted from the article]