A novel device for endoscopic submucosal dissection, the Fork knife

Figure 4 ESD using the Fork knife. A: Indigo carmine spray for deciding the tumor border; B: Circumferential marking by the fixed flexible snare tip with soft coagulation current; C: Making an incision with a fixed flexible snare in ENDOCUT mode; D: Circumferential mucosal incision at the periphery of the marking dots; E: Dissecting the submucosal layer with a forked knife; F: Additional submucosal injection using the long tip of the forked knife without changing accessories; G: Dissecting the submucosal layer with a fixed flexible snare; H: Large ESD defect after complete en bloc resection.