Lateral spreading lesions (LSL) of the duodenum are uncommon. They may or may not involve the papilla Vatteri and are usually solitary flat adenomas that harbor a malignant potential similar to colonic adenomas and removal is therefore recommended.1,2 Endoscopic mucosal resection (EMR) is well-established as effective and safe for removal of large colonic LSLs and in recent years has gained acceptance in the treatment of duodenal LSL with good overall results.3,4 Complete resection is achieved in 79%-100% of cases at the index procedure, with bleeding and perforation occur at rates of 33% and 3%, respectively, and recurrence seen in 10%-37%.