Fig. 2.

The endoscopic submucosal dissection (ESD) procedure. (A) On the anterior wall of the antrum, a 1.2-cm type IIa early gastric cancer is found. (B) Indigocarmine is sprayed along the extent of tumor to aid visualization. (C) Marking outside the lesion. (D) After injection of saline mixed with diluted epinephrine (1:100,000) and indigocarmine into the submucosal layer, circumferential mucosal pre-cutting is performed using a standard needle knife. (E) After dissection of the submucosal layer, a post-ESD induced ulcer is seen. (F) Fixation of the tissue specimen.