TIPS AND FUNDAMENTALS OF COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION WITH A SCISSOR-TYPE KNIFE (WITH VIDEOS)

Abstract

Colorectal endoscopic submucosal dissection (ESD) with a scissor-type knife does not require complex endoscopic movements and techniques, and thus, it can be performed relatively safely and easily. Since the usage of scissor-type knives is fundamentally different from conventional ESD knives, it is important to become familiar with the features of both types of knives. With a scissor-type knife, circumferential mucosal incision is performed “like cutting paper” without applying too much tension to the tissue being resected, and submucosal dissection with imaging proceeds while “connecting optimal depths of resection point by point”. In this article, we focus on the procedure of colorectal ESD with a scissor-type knife and describe fundamentals and tips for using the scissor-type knife in detail to reduce the operative time. Since the scissor-type knife is highly useful as a secondary device in difficult situations, we highly recommend mastering the use of the scissor-type knife.