Volume 3, Issue 7, Pages (July 2018)

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Volume 3, Issue 7, Pages 223-225 (July 2018) Colorectal endoscopic submucosal dissection for a lesion on the dentate line area resected with a scissor-type knife Naohisa Yoshida, MD, PhD, Yutaka Inada, MD, PhD, Takaaki Murakami, MD, PhD, Yuji Naito, MD, PhD, Yoshito Itoh, MD, PhD VideoGIE Volume 3, Issue 7, Pages 223-225 (July 2018) DOI: 10.1016/j.vgie.2018.04.011 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 A lesion on the rectum and the dentate line area. A, Dentate line section. B, Rectal section. C, Linked color imaging showing a clear tumor margin. D, Magnified blue laser image showing a slightly irregular surface pattern. VideoGIE 2018 3, 223-225DOI: (10.1016/j.vgie.2018.04.011) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Clutch Cutter 3.5 mm (Fujifilm Co, Tokyo, Japan). A, Full-open style. B, Half-open style. This style is easy for rotating the knife in the appropriate direction. VideoGIE 2018 3, 223-225DOI: (10.1016/j.vgie.2018.04.011) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Colorectal endoscopic submucosal dissection with Clutch Cutter. A, To prevent the knife from slipping, we incised a small amount of mucosa electrosurgically using a Clutch Cutter in the full-open style of this knife (ERBE: VIO 300D, endocut I, effect 2, duration 4, interval 1). B, We caught the mucosa with the knife and incised it using the same electrosurgical setting. C, D, We performed submucosal dissection with 2 electrosurgical modes (forced coagulation effect 2, 30 W, endocut I effect 2, duration 4, interval 1). E, After checking an oral-sided blue color sign (caused by the blue injection solution) we performed a total circumferential incision. F, Palpable or large nonpalpable vessels were precoagulated (soft coagulation, effect 4, 100 W) and were dissected with forced coagulation. G, H, Finally, the lesion was resected en bloc in 38 minutes (diameter, 30 × 24 mm). Histologic examination showed high-grade adenoma with free margin. VideoGIE 2018 3, 223-225DOI: (10.1016/j.vgie.2018.04.011) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions