Endoscopic submucosal dissection using the insulated-tip knife

Endoscopic submucosal dissection (ESD) has become standard treatment for early gastric and esophageal cancer in Japan. Nearly 10 years have passed since the insulated-tip knife was developed, and the improved type insulated-tip (IT) knife-2 is a more powerful device for ESD. The development and progress of the ESD technique were realized with much cooperation from others who developed the technique of endoscopic mucosal resection, from surgeons who were always available when complications occurred, and from colleagues who worked together in friendly competition. With many thanks for their contributions, the current status of the ESD technique with the IT knife in the stomach, esophagus, and colorectum, as well as its complications, will be discussed.