Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection

Lingenfelder, Tobias; Fischer, Klaus; Sold, M.; Post, Stefan; Enderle, Markus D.; Kaehler, Georg

doi:10.1007/s00464-009-0433-3

Cited by 44 publications

(26 citation statements)

References 19 publications

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“…The feasibility of this new device and technology has been tested in the porcine model. Lingenfelder et al 13 reported that the use of HybridKnife with water-jet function shortened the procedure time and injury to the MP. Subsequent studies on the colon and esophagus in porcine models were reported.…”

Section: Discussionmentioning

confidence: 98%

“…11 A new system, the HybridKnife, combines electrosurgical technology with a novel water-jet system (ERBEJET 2; ERBE, Tübingen, Germany) that allows rapid needle-free infusion of saline solution in the submucosa to lift a target mucosal lesion. 12,13 Marking, injection, mucosal incision, submucosal dissection, and quite often hemostasis can be performed with this one instrument. This new ESD device may increase the safety of ESD and shorten the procedure time compared with conventional ESD (C-ESD).…”

mentioning

confidence: 99%

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Prospective, randomized study of conventional versus HybridKnife endoscopic submucosal dissection methods for the esophagus: an animal study

Fukami

Ryu

Said

et al. 2011

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Prospective, randomized study of conventional versus HybridKnife endoscopic submucosal dissection methods for the esophagus: an animal study

Fukami

Ryu

Said

et al. 2011

Gastrointestinal Endoscopy

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“…A new injection device has been introduced, which uses a high-pressure fluid jet though an open tip catheter sans needle that drives the injection solution through the mucosa into the submucosa, creating a fluid cushion similar to that produced by a needle injector. This has been combined with an integral cutting tip (through which the stream is directed) to provide one device that can provide more than a single function [7][8][9]. Fluid that may be injected for polypectomy is often saline, and some endoscopists add a few drops of methylene blue to the injection solution to add color, which may assist in visualization of the edges of the adenoma, which will appear as pink tissue on a bed of blue fluid, rendering easier visualization of the polyp edge.…”

Section: Fluid Injection For Polypectomymentioning

confidence: 99%

Complicated Polypectomy

Waye¹,

Sano²

2011

Successful Training in Gastrointestinal Endoscopy

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One of the major advances in medicine during the last 50 years has been the colonoscopic removal of colon polyps, which has decreased the incidence, morbidity, and mortality of colorectal cancer. Most polyps in the large bowel are less than 1 cm in diameter, a size that has enabled successful treatment of polyps and has permitted the relatively easy removal of polyps throughout the world. Only 20% of polyps are over 1 cm in size, with most large polyps (over 20 mm) being adenomas.The removal of colon polyps requires the ability to transect a polyp, while simultaneously preventing bleeding and maintaining the integrity of the colon wall during use of electrothermal current. The successful removal of colon polyps by the snare and cautery technique involves a balance between the act of transection and the hemostasis that is required. During removal of large polyps, the two forces that must be balanced are the shearing force from closing the wire loop and the thermal energy, which results in cauterization of blood vessels providing hemostasis. Both the shearing force and hemostasis must be achieved simultaneously to permit removal of polyps without bleeding and with the safe application of thermal energy to the thin colon wall without a deep zone of thermal destruction. The closure of the snare can result in cutting through a polyp but guillotine of a polyp can often be associated with bleeding; the application of thermal energy alone through the wire loop without a shearing force will cause deep thermal injury without the ability to sever a polyp. It is important that both forces, shearing and application of heat, must be used simultaneously. Small polyps, up to 5 mm in diameter, have small nutrient blood vessels and are often successfully removed by "cold" snare transection (without the application of thermal energy) with no significant bleeding. Most polypectomies are performed without any blood loss because hemostasis during polypectomy is very similar to hemostasis in any type of bleeding: pressure on a blood vessel to stop the flow of blood. In polypectomy, that principle is achieved by squeezing a blood vessel with the snare to occlude the vascular channel prior to heat sealing it with thermal energy. By tightly closing the snare around a polyp, the blood vessel walls are coapted in a similar fashion to that employed for cessation of hemorrhage from an ulcer in the upper intestinal tract. In a bleeding gastric ulcer, for example, hemostasis is usually achieved by pushing on a vessel with a probe (BICAP or heater probe) and then applying heat which obliterates the vascular channel. During polypectomy, once the blood vessel walls have been coapted by squeezing the snare, permanent hemostasis is achieved by employing thermal energy, which seals the coapted blood vessel through which blood is no longer flowing. This is effective for pedunculated polyps that have a single arterial supply as well as for sessile polyps where several smaller vascular channels exist. The electrosurgical unitIt is important for the succ...

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“…For several years, our group has focused on the effect of a high-pressure water jet application on the gastrointestinal wall [8][9][10][11]. The water jet dissector has been used successfully for the dissection of parenchymatous organs, mainly the liver, by exploiting the water jet's tissue selectivity [12][13][14][15].…”

mentioning

confidence: 99%

Selective tissue elevation by pressure for endoscopic mucosal resection of colorectal adenoma: first clinical trial

et al. 2011

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Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection

Abstract: The combination of a needle-knife with high-pressure water-jet dissection improved the results of endoscopic submucosal dissection in this experimental setting. Because the frequency of complications is still high, further improvements to the instrument are necessary.

Cited by 44 publications

References 19 publications

Prospective, randomized study of conventional versus HybridKnife endoscopic submucosal dissection methods for the esophagus: an animal study

Prospective, randomized study of conventional versus HybridKnife endoscopic submucosal dissection methods for the esophagus: an animal study

Complicated Polypectomy

Selective tissue elevation by pressure for endoscopic mucosal resection of colorectal adenoma: first clinical trial

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