Clin Endosc.  2017 May;50(3):219-223. 10.5946/ce.2017.078.

History and Development of Accessories for Endoscopic Submucosal Dissection

  • 1Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Hospital , Bucheon, Korea.


Endoscopic submucosal dissection (ESD) procedure is composed of circumferential mucosal incision and submucosal dissection. A variety of endoscopic accessories are required to perform mucosal incision and submucosal dissection safely. As a result of the improvements in ESD devices and peripheral equipment and development of the ESD technique, ESD procedures have been performed extensively worldwide. Here I review the history of the development of accessories used in performing ESD procedures.


Dissection, Endoscopic submucosal; Endoscopic mucosal resection; Endoscopic accessory; Mucosal incision


  • Fig. 1. Blunt tip endoscopic submucosal dissection (ESD) knives. (A) IT knife (Olympus, Tokyo, Japan). (B) Safe Knife V (Fujifilm, Tokyo, Japan). (C) Mucosectom (Pentax, Tokyo, Japan). (D) Swan blade (Pentax, Tokyo, Japan).

  • Fig. 2. Tip-cutting endoscopic submucosal dissection (ESD) knives. (A) Hook knife (Olympus, Tokyo, Japan). (B) Flex knife (Olympus, Tokyo, Japan). (C) Dual knife (Olympus, Tokyo, Japan). (D) Flush knife BT (Fujifilm, Tokyo, Japan). (E) Hybrid knife (ERBE, Erlangen, Germany).

  • Fig. 3. IT knife series (Olympus, Tokyo, Japan). (A) Original IT knife. (B) IT knife 2. (C) IT knife nano.

  • Fig. 4. Dual knife J™ (Olympus, Tokyo, Japan).

  • Fig. 5. Stage beetle knife Jr (Sumitomo Bakelite Co., Tokyo, Japan).

  • Fig. 6. Each knife for gastrointestinal (GI) endoscopic submucosal dissection (ESD) and its release year. Adapted from Tanaka et al. [11].

  • Fig. 7. Distal attachment (Olympus Medical System, Tokyo, Japan).

  • Fig. 8. Development of the ST hood (Fujifilm, Tokyo, Japan).

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