Innovative endoscopic devices have been developed and are now commercially available, which have contributed to the spread of the endoscopic submucosal dissection (ESD) technique for superficial neoplastic lesions.1 In particular, needle-type diathermy knives with a waterjet function enable injection into the submucosal area from the tip of the knife immediately after the cutting maneuver.2,3 This may reduce the number of times the knife is moved through the working channel, leading to a shorter procedure time.