Response to the letter by Matsushita et al. regarding our manuscript “Resection Depth and Layer of Cold Snare Polypectomy versus Endoscopic Mucosal Resection”

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We thank Dr. Matsushita et al. for their comments on our article "Resection Depth and Layer of Cold Snare Polypectomy versus Endoscopic Mucosal Resection". However, it appears that their arguments are based on the perspective of mucosal lesions. In mucosal lesions without submucosal invasion, we agree that the submucosal thickness of the resected specimen is not an important matter because it does not affect treatment outcome. In the clinical setting, however, we have encountered diminutive polyps that were apparently mucosal lesions as well as small polyps of 6–9 mm in diameter. In another study, small polyps contained 4% of category 4 or 5 polyps; of those, 6% were deep invasive cancers with lymph node metastasis requiring further surgical treatment [1]. Moreover, some of the malignant small polyps were nonpolypoid and not easily recognized as invasive before endoscopic resection. …