A novel device for endoscopic submucosal dissection, the Fork knife

Figure 1 The Fork knife (Endo FS^®).

Figure 2 Working body of the Fork knife. Two switches, the fork knob and core knob, are located on the center of the body and enable the knives to be changed during the procedure. A material inlet for injection and irrigation is located forward of the body.

Figure 3 Close-up views of the two inter-changeable knives of the Fork knife. A: Fixed flexible snare knife; B: Forked knife with a double-bladed tip; C: Saline irrigation can be performed using either 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.