Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful procedures

Figure 5 Three steps of safe submucosal dissection using a scissor-type endoknife (SBknifeJr) in case of a vertical approach. A: The endoscope was rotated and the exfoliated mucosa was turned down with a tip of an endoknife to clearly visualize the submucosal layer to be dissected along with the scissor tips; B: The edges of the scissor-type endoknife was opened; C: The submucosal layer under the exfoliated mucosa could be safely dissected by grasping and pulling up with the endoknife before application of an electrical current. Repeating these procedures led to the creation of the mucosal flap and successful endoscopic submucosal dissection.