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We then identified the bleeding diverticulum, but were unable to identify the bleeding vessels within the diverticulum because of the severe active bleeding (Fig. Although various endoscopic hemostasis techniques for colonic diverticular bleeding have recently been reported [1], identifying the bleeding diverticulum among other diverticula is difficult [2], and identifying the bleeding vessels within the diverticulum is even more difficult. [Extracted from the article]

B Video 1 b Resection of a protruding tumor with the muscle-retracting sign during rectal endoscopic submucosal dissection using the isolation method and picking technique with a clutch cutter. Endoscopic submucosal dissection (ESD) has become widely used for treatment of colorectal tumors, but there are resections of protruding tumors with the muscle-retracting sign of the ESD procedure that are still difficult to manage [1]. [Extracted from the article]

Thus, the submucosal fibrous tissue could be identified through the hematoma, and was dissected despite the presence of the hematoma. 2 a Endoscopic image of the submucosal layer with severe hematoma observed using white light. b Endoscopic image of the submucosal layer with severe hematoma observed using red dichromatic imaging (RDI). [Extracted from the article]

2 a The blood vessel penetrating the muscle layer was covered with submucosal and fatty tissue, as observed by white light. b The blood vessel could be identified more clearly than the surrounding tissue using red dichromatic imaging. We were able to easily detect the exposed blood vessels using red dichromatic imaging because the color difference between the exposed blood vessels and surrounding tissue was clear. [Extracted from the article]

In an unstable setting, even if the ESD knife is manipulated by removing one's right hand from the endoscope, the weight of the main body of the Multi-Clamp allows the endoscope to be fixed in place, allowing visibility to be maintained during the surgery. Before insertion of the endoscope, a Multi-Clamp was clamped with gauze into the base (near the opening of the forceps) of the soft part of the endoscope, which was then inserted. [Extracted from the article]