Treatment of over 20 mm gastric cancer by endoscopic submucosal dissection using an insulation-tipped diathermic knife

Figure 1 The procedure of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD). A: Marks are made at several points along the outline of the lesion with a coagulation current; B: Completion of the IT-knife cutting around the lesion with a safe lateral margin; C: Abrasion of the submucosal tissue under the circumcised area with IT-knife (white arrow; D: The tumor is completely resected with IT-knife and without using snaring.