Endoscopic Submucosal Dissection Techniques

Endoscopic submucosal dissections were performed by using Fujifilm colonoscopes 9 (Fujifilm, Tokyo, Japan) (EC-760R-VL/EC-760ZP-VL). CO₂ gas was used in all cases. Two types of electrosurgical generators (VIO 300D or VIO 3, ERBE, Tübingen, Germany) were used. The knives were Flush-knife (Fujifilm, Tokyo, Japan) or HybridKnife (Erbe Elektromedizin, Tübingen, Germany). The technique adopted for the ESD (Figure 4) was chosen according to operator preference and included either the “conventional” [21 (link)], pocket [22 (link)], or tunnel technique [23 (link)]. Various traction methods to better expose the submucosal layer were applied [24 (link)]. Local injection was performed with either saline or glyceol with indigo carmine.