Figure 3.

Schematic shows ESD using GSF. Step 1: Marking dots are made on the circumference of the lesion to outline the incision line; Step 2: 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 3: The lesion is separated from the surrounding normal mucosa by complete incision around the lesion using the GSF; Step 4: A piece of submucosal tissue is grasped by GSF; Step5: A grasped tissue is lifted up and cut with the GSF using electrosurgical current to effect submucosal exfoliation; Step 6: The lesion is resected in one piece; m: Mucosa; sm: Submucosa; mp: Muscularis propria.