What I'm going to now use is, of course, the injection technique with a needle. This is something that anybody can do because you don't have to have a hybrid generator for this. I am now going to this area below the squamous columnar junction. You could see it very easily earlier. Then I'm going to inject here. This is a standard injection needle that we use for all the standard submucosal injections. What I'm going to do is, I'm going to... Nagi, you're again using saline with a few drops of a blue dye? Indigo carmine, yeah. Indigo carmine. Nagi, while you're doing this, tell us about the arms thing. The reception part really did not help that much. The same thing can be done in terms of resection. The problem with resection is sometimes the bleeds are a problem, so therefore, it's a little more technically difficult procedure. You see, I created a nice bulge there, submucosally, and now I'm going to do the APC. When you do the APC, what you have to do is, one centimeter on the lateral side, and on the lesser curve side, I do two centimeters, so it's not exactly circumferential, it's a horseshoe with a tail coming onto the lesser curve side. We know from submucosal endoscopy, Nagi, that this is the most vascular part of the stomach. Exactly, yeah. Moyen is absolutely right, and that's the reason why, of course, we used to do a lot of arms earlier. They used to be bleeds, but of course, you can control these bleeds very often, but what we find is that with this, the chance of that is not there, so it's very technically very easy. The technique is I'm holding my scope in the right hand with the probe outside, so I don't manipulate the probe, and as I can sort of spray, this is the first population, so I get a spray here. I have to keep away from the G-junction, it's about one centimeter, this side, see this? It's about one centimeter here, and then when I go to the lesser curve side, it's going to be longer, the tail here, so it's a very easy procedure, and the chance of complication is... So, Nagi, again, you're following the same principles of APC here, in which you're trying to form that arc and get the mucosal ablation on that. Now, as you're doing this, what's the end point you're looking for on the mucosal side? Is there anything specific in terms of either a color or the charring? I mean, how do you define that you have enough ablation? So, this is very subjective. We don't have any objective way to define it, but usually when you get a whitish color, that's optimum. If it's brownish, it's a little more deeper you've gone into, but it doesn't matter, but one would want it to be a little more whitish there, so you get a whitish appearance here.

injection technique

needle

submucosal injections

APC

ablation