Precutting and trimming-assisted underwater endoscopic mucosal resection for large early esophageal cancer

A 72-year-old man was diagnosed with early esophageal cancer and underwent endoscopic resection. After marking the lesion, the size was about 4.0 × 3.0 cm. After submucosal injection, mucosal incision was performed with Endocut Q (Effect 3, Cut duration 2, Cut interval 4), followed by the trimming of the edges with swift coagulation (Effect 3, 45 W), the so-called precutting and trimming technique ([Fig. 1 a]). Because the marginal mucosa had been fully incised, under the condition of continuous water injection, the lesion floated in the water, which allowed it to be completely snared and removed using a 30-mm snare ([Fig. 1 b]). No residual lesion, bleeding, or perforation was observed on the wound ([Fig. 1 c]). The whole operation lasted 20 minutes. Iodine staining after the specimen was stretched and fixed confirmed the presence of all the marks and the size of 4.2 × 3.0 cm ([Fig. 1 d]). The histological findings revealed pathological lamina propria (pT1a-LPM) squamous cell carcinoma with negative horizontal and vertical margins.