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ESD was performed under conscious sedation (6 patients) or general anesthesia (4 patients) using a colonoscope (CF-Q260 or CF-HQ290, Olympus) with an attached transparent cap. Carbon dioxide was used for insufflation. Other equipment and accessories used during the procedure included a high-frequency generator (VIO 200D; ERBE), an argon plasma coagulation unit (APC300; ERBE), various dissecting knives (hybrid knife, dual knife, and insulation-tip knife), an injection needle (NM-4L-1; Olympus), and hemostatic clips (HX-600-90; Olympus).

The following equipment and accessories were used: a single-channel endoscopy (Q260j; Olympus, Tokyo, Japan), magnifying endoscopy (EC-590ZW/M; Fujinon, Fuji, Japan), EUS (SU-8000; Fujinon), transparent cap (Olympus), IT knife (Olympus), hook knife (Olympus), ERBE electrosurgical coagulation unit with a high-frequency generator (ICC-200; Elektromedizin GmbH, Tübingen, Germany), injection needles (NM-4L-1; Olympus), metallic clip (Olympus), sterile repositionable hemostasis clip (Nanjing Micro-Tech, Nanjing, China), endoloop (MAJ-254; Olympus).

A forward-viewing endoscope (GIFQ240Z; Olympus, Tokyo, Japan) was used with a transparent distal cap attachment (MH-588; Olympus). A hook knife (KD-620L; Olympus) and an injection needle (NM-4L-1, Olympus), or a hybrid knife (ERBE, Tübingen, Germany) were used to dissect the submucosal layer and the tumors. A pair of coagulating forceps (Coagrasper, FD-410L; Olympus) was used to coagulate large vessels prior to dissection and for hemostasis. A carbon dioxide (CO₂) insufflator (UCR; Olympus) was used. For electrosurgery, a VIO 200 D electrogenerator (ERBE) was used, and for final closure of the mucosal entry site, hemostatic clips (EZ-CLIP, HX-110QR, Olympus; or Resolution, M00522610; Boston Scientific, Boston, United States) were applied. All the ESTD procedures were performed by a single operator (Gong W).
The patients underwent the procedures under general anesthesia with endotracheal intubation. CO₂ was used during the procedure. The standard steps of the procedure were described previously (Figures 1 and 2)[15 (link)].

ESE was performed under general anesthesia through tracheal intubation. A carbon dioxide insufflator (UCR; Olympus, Tokyo, Japan) was used. Other equipment and accessories included a high-frequency generator (VIO 200D; ERBE, Tübingen, Germany), an argon plasma coagulation unit (APC300; ERBE), a hybrid knife (ERBE), a dual knife (KD-650Q; Olympus), an insulation-tip knife (KD611L, IT2; Olympus), an injection needle (NM-4L-1; Olympus), and hemostatic clips (HX-600-90; Olympus).