2.6. ESD procedures
polyps
The endoscope will be inserted into the colon; after identifying the lesion, its periphery will be marked when necessary. Solution will be injected into the submucosa and submucosal dissection will be continued until completion. There were no restrictions regarding endoscopes, needles, hemostats, and hoods, although only the Dual Knife (Olympus) was allowed for marginal incisions and submucosal dissection. Upper endoscopy was allowed, depending on the situation. EMR on other polyps was allowed before or after ESD on the same day. To ensure patient safety, for patients in whom it is impossible to complete the procedure, the trainee could be replaced by a specialist, thus allowing the procedure to continue. Trainees assigned to a procedure that has lasted more than 60 minutes but who are unable to continue the assigned procedure will be allowed to switch to the other procedure. Physicians having difficulty completing conventional ESD within 60 minutes will be allowed use of the S-O clip midway through the procedure. Conversely, physicians having difficulty completing ESD with the S-O clip within 60 minutes, due to interference by the S-O clip, will be allowed to remove the clip. Antithrombotic medications will be withdrawn or replaced according to gastrointestinal endoscopic practice guidelines.