GI endoscopic submucosal dissection using a calibrated, small-caliber-tip, transparent hood for lesions with fibrosis

To date, various methods to manage severely fibrotic lesions encountered during endoscopic submucosal dissection (ESD) have been described. In this regard, the method of dissecting the submucosa on both sides of the fibrotic area before dissecting the severely fibrotic part has been reported to be beneficial.1,2 In particular, the pocket-creation method (PCM) is considered to be a useful method for adding adequate traction to the fibrotic area by using a small-caliber-tip, transparent (ST) hood with a tapered tip and allowing the muscles to be approached in parallel.