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Kuwai et al. Mini-invasive Surg 2022;6:16 https://dx.doi.org/10.20517/2574-1225.2021.122 Page 7 of 8

Figure 5. Colorectal endoscopic submucosal dissection (ESD) using the SB Knife Jr: (A) submucosal injection was started from the anal
side; (B) circumferential incision similar to cutting paper with scissors; (C) submucosal dissection by grasping the target tissue (1/3
from the bottom of the submucosa); (D) pulling the knife slightly and after confirming the safety and applying the electric current for
cutting; (E) prophylactic hemostasis for large vessels; (F) submucosal dissection advanced towards the oral side of the lesion; (G)
mucosal defect after en bloc resection; and (H) pathological mapping with the histology showing intramucosal cancer with a negative
margin.

time was 57 min. The pathological diagnosis was well-differentiated tubular adenocarcinoma pT1a
(SM1/190 μm), 36 mm in diameter. This was a curative resection [Figure 5H].

CONCLUSION
In this article, we focus on the tips and tricks of using the SB Knife Jr for colorectal ESD. The SB Knife Jr has
potential advantages, allowing easy and safe colorectal ESD. All the steps of ESD procedures, including
mucosal incision, submucosal dissection, and hemostasis, can be achieved with one knife. Complex scope
manipulation and advanced endoscopy skill may not be required due to the grasping and cutting technique
of this scissor-type knife. Because it is instrumental as a secondary device in difficult situations, we highly
recommend that endoscopists master its use.

DECLARATIONS
Acknowledgments
The authors extend thanks to Naoko Matsumoto for data collection and administrative assistance.

Authors’ contributions
Designed the research and wrote the article: Kuwai T
Providing critical intellectual input for the revised manuscript: Tamaru Y, Kusunoki R, Ishaq S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.