Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

Figure 1 Pretherapeutic examinations of rectal carcinoid. A: Endoscopic view of the small rectal carcinoid; B: EUS showing a hypoechoic solid tumor (t) in the superficial submucosa. Arrow-mp: Muscularis propria.

Figure 2 Distal tip of the GSF. The outer side of the forceps is insulated so that electrosurgical current energy is concentrated at the blade to avoid burning the surrounding tissue.

Figure 3 Schematic shows ESD using GSF. Step 1: A concentrated glycerin solution mixed with a small volume of epinephrine and indigo carmine dye is injected into the submucosal layer around the target lesion to lift the entire lesion; Step 2: The lesion is separated from the surrounding normal mucosa by complete incision around the lesion using the GSF; Step 3: A piece of submucosal tissue is grasped and cut with the forceps using an electrosurgical current to effect submucosal exfoliation; Step 4: The lesion is resected in one piece. m: Mucosa; sm: Submucosa; mp: Muscularis propria; t: Tumor.

Figure 4 ESD using GSF of rectal carcinoid. A: Endoscopic view of the partial circumferential incision of the tumor using GSF; B: Endoscopic view of the submucosal exfoliation under the tumor using GSF; C: The lesion is cut completely from the muscle layer; D: The resected specimen showing curative en bloc resection of the lesion.