Volume 4, Issue 7, Pages (July 2019)

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Volume 4, Issue 7, Pages 314-318 (July 2019) Colorectal endoscopic submucosal dissection with use of a bipolar and insulated tip knife Yutaka Saito, MD, PhD, FASGE, Shih Yea Sylvia Wu, FRACP, Mai Ego, MD, Seiichiro Abe, MD, PhD VideoGIE Volume 4, Issue 7, Pages 314-318 (July 2019) DOI: 10.1016/j.vgie.2019.04.019 Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Equipment and preparation for colorectal endoscopic submucosal dissection (ESD). VideoGIE 2019 4, 314-318DOI: (10.1016/j.vgie.2019.04.019) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 A, Lateral spreading tumor, nongranular type pseudodepressed type, 0-IIa+IIc located in ascending colon. Tumor was 3 cm in diameter with prominent fold stretching. B, Narrow-band image (NBI) revealing a clear tumor margin. C, After indigo carmine dye spraying margin of tumor became clearer, and a slight reddened depression was prominent in the center. D, Close-up view with indigo carmine dye. E, Magnified NBI revealing Japan NBI Expert Team (JNET) type 2A (regular vessel and regular surface patterns) in slightly elevated area suggesting low-grade intramucosal neoplasia. F, Magnified NBI revealing JNET type 2B (irregular vessel and irregular surface patterns) in depressed area suggesting high-grade intramucosal neoplasia or submucosal superficial cancer. G, Magnified view with indigo carmine dye revealing IIIl pit or Vi (low-grade) (noninvasive) pit pattern in the depressed component. H, Crystal violet stain revealing type Vi (low-grade) (noninvasive) pit pattern suggesting intramucosal neoplasia or submucosal superficial cancer. VideoGIE 2019 4, 314-318DOI: (10.1016/j.vgie.2019.04.019) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 A, Resected specimen stretched with care on a measuring board with small pins. B, Indigo carmine dye sprayed on the resected specimen to enable visualization of the cut margin. VideoGIE 2019 4, 314-318DOI: (10.1016/j.vgie.2019.04.019) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 A, Resected specimen showing histopathologic diagnosis of well-differentiated tubular adenocarcinoma, low-grade and high-grade atypia (H&E, orig. mag. × 50). B, Resected specimen with desmin staining, which is routinely conducted for the diagnosis of submucosal invasive cancer, showing slight submucosal invasion (orig. mag. × 50). VideoGIE 2019 4, 314-318DOI: (10.1016/j.vgie.2019.04.019) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions