ESD was performed under conscious sedation by experienced and novice endoscopists in the university hospital setting. Novice endoscopists referred to colonoscopists who had performed fewer than 100 colorectal ESD procedures. A standard colonoscope (PCF-Q260J; Olympus, Tokyo, Japan) or a gastroscope (GIF-Q260J; Olympus, Tokyo, Japan) were used with appropriate distal attachment. The injection solution was a mixture of normal saline and 0.4 % sodium hyaluronate (MucoUp; Johnson & Johnson, New Brunswick, New Jersey, United States) with a small amount of indigo carmine. A FlushKnife (Fujinon-Toshiba ES System Co., Omiya, Japan), DualKnife (KD-650L; Olympus, Tokyo, Japan), and/or SB Knife Jr (Sumitomo Bakelite, Tokyo, Japan) and hemostatic forceps (Coagrasper; Olympus, Tokyo, Japan) were used as appropriate. The ESD procedure was classified as one of two methods: conventional ESD or hybrid ESD. Conventional ESD involved submucosal dissection with a knife, and hybrid ESD involved snaring following circumferential incision and sufficient submucosal dissection
20 (link)
.