Endoscopic submucosal tunnel dissection salvage technique for ulcerative early gastric cancer

Figure 2 Key procedures of the endoscopic submucosal tunnel dissection salvage technique. A: An area surrounding the early gastric cancer (EGC) lesion and tunnel gate is marked with argon plasma coagulation; B: A solution containing saline and sodium hyaluronate with diluted epinephrine and indigo carmine is injected into the submucosal layer around the EGC lesion and tunnel area; C: A hook knife is used to make an incision at the tunnel gate and a circumferential incision surrounding the lesion; D: A tunnel dissection of the EGC lesion is made with a hook knife and an endoscopic submucosal dissection cap; E: The EGC margin is confirmed and the lesion is directly dissected; F: The resected lesion and the overlying tunnel mucosae are removed without clipping.