- Define the borders:
- Use the ESD knife or argon plasma coagulation to mark the perimeter of the lesion at least 5mm beyond its visible margin.
- This ensures clear margins during dissection.
- Create a submucosal cushion:
- Inject a solution (e.g., saline, glycerol, hyaluronic acid, or a mixed solution with epinephrine and indigo carmine).
- This separates the lesion from the muscularis propria, facilitates dissection, and reduces the risk of perforation.
- Reinject as needed during the procedure.
- Circumferential mucosal incision:
- Use the ESD knife to incise the mucosa around the marked borders.
- Start with a small incision and extend it to encircle the lesion completely.