Endoscopic submucosal dissection using the Flex and the Dual knives

Yahagi, Naohisa; Uraoka, Toshio; Ida, Yosuke; Hosoe, Naoki; Nakamura, Rieko; Kitagawa, Yuko; Ogata, Haruhiko; Hibi, Toshifumi

doi:10.1016/j.tgie.2011.02.006

Cited by 46 publications

(35 citation statements)

References 5 publications

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“…17-50 a gastroscope GIF H180J or pediatric colonoscope PCF-H180-I (Olympus; upwards bending 210°, centered water jet) with a straight-shape transparent hood (D-201-11804®). We used CO 2 insufflation, a Dual Knife® and/or Hook Knife®, for larger vessels Coagrasper® forceps, and, when appropriate, monofil snares (all from Olympus) powered by VIO-300D electrosurgical generator (ERBE, Tübingen, Germany) as recommended [6,8]. …”

Section: Methodsmentioning

confidence: 99%

“…The submucosal layer was lifted by injections (2-4 ml each) of sterile 10% glycerol solution (Glyceol®; Chugai Pharmaceutical, Tokyo, Japan) often with 0.4% sodium hyaluronate (Sigma-Visc®; Hyaltech Ltd., Livingston, UK) for longer lasting submucosal lifting. The dual knife and hook knife were applied as described [6,8]. The dual knife was preferred for mucosal incision and mainly tangential knife approach, hook knife for perpendicular knife approach and difficult submucosal dissection, because the hook-shaped tip of the knife is clockwise (360°) rotatable in any desired position directed away from proper muscle layer, but learners tend to work slower with hook knife than dual knife.…”

Section: Methodsmentioning

confidence: 99%

“…The dual knife was preferred for mucosal incision and mainly tangential knife approach, hook knife for perpendicular knife approach and difficult submucosal dissection, because the hook-shaped tip of the knife is clockwise (360°) rotatable in any desired position directed away from proper muscle layer, but learners tend to work slower with hook knife than dual knife. The strategy aimed for a best gravity-dependent plan of sequential mucosal incision and submucosal dissection in order to expose the submucosal space for resection of the entire lesion (ESD en-bloc) [6,7,8] (fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…This requires tissue recognition in submucosa, gravity-supported resection strategy, electrosurgical experience, and skills to prevent or handle complications such as bleeding or organ perforation [6,7,8]. In Japan, learners receive clinical training for competence under tutoring by experts [9,10,11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

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Untutored Learning Curve to Establish Endoscopic Submucosal Dissection on Competence Level

Berr¹,

Wagner²,

Kiesslich³

et al. 2014

Digestion

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Backgrounds/Aims: Endoscopic submucosal dissection (ESD) of early cancer allows precise staging and avoids recurrence or surgery. Tutored by experts, ESD has rapidly spread in Japan, but still demands untutored learning in Western countries. A step-up approach starts with easiest gastric neoplasias, but fails on their low prevalence in Western countries. A prevalence-based approach includes challenging colonic neoplasias. Methods: We analyzed an untutored series of initial 50 ESD procedures by an experienced endoscopist on consecutive lesions referred according to prevalence. Results: Overall, 48 lesions (20% upper gastrointestinal, 80% colorectal; 2 hyperplastic (inflammatory) lesions, 46 neoplasms) were completely resected intention-to-treat with ESD, 2 required a second ESD. Neoplasias were resected 76% en-bloc (46% ESD, 30% ESD with snaring), 17% by ESD with snaring in 2-3 pieces, and 6.5% as ESD with snaring in multiple pieces. None of 15 neoplasias with high-grade intraepithelial neoplasia or an early esophageal cancer (R0) had recurred. Complications were 2 bleedings (4%) and 7 perforations (14%), 5 clipped and 2 (4%) operated. All patients were discharged within 9 days without long-term morbidity. Conclusion:Untutored learning of ESD is feasible on colonic lesions. We propose to establish ESD in Europe with structured training and a prevalence-of-lesions-based approach.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Untutored Learning Curve to Establish Endoscopic Submucosal Dissection on Competence Level

Berr¹,

Wagner²,

Kiesslich³

et al. 2014

Digestion

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“…The first of these is a shorter, thinner needle knife with a small apical disk at the tip the Dual knife (KD-650Q: Olympus), which is an improved version of the Flex knife ( Figure 1A) [21] . The latest design overcomes some of the previous problems with the Flex knife such as difficulty in adjusting knife length, frequent accumulation of debris at the knife tip during ESD and slippage of the knife tip away from the endoscopic operating field especially in cases involving scarring or loose tissues.…”

Section: Electrosurgical Knivesmentioning

confidence: 99%

What are the latest developments in colorectal endoscopic submucosal dissection?

Uraoka

Saito²,

Yahagi³

2012

WJG

Self Cite

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Endoscopic submucosal dissection (ESD) enables direct submucosal dissection so that even large early-stage gastrointestinal tumors can be resected en bloc . ESD has recently been applied to the colorectum since it was originally developed for use in the stomach. However, colorectal ESD is technically more difficult with an increased risk of perforation compared with gastric ESD. In addition, this procedure is seldom performed in Western countries. Consequently, further technical advances and the availability of a suitable clinical training system are required for the extensive use of colorectal ESD. In this topic highlight, we review the most recent developments in colorectal ESD.

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Ultrasonic cleaning is effective in removing carbonized clots and tissue from the insulation‐tipped diathermic knife‐2

Murakami¹,

Hirata

Haraguchi³

et al. 2022

DEN Open

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Objectives Since carbonized clots and tissue (debris) tend to adhere firmly to the tip of the endoscopic submucosal dissection (ESD) knife as the procedure proceeds, manual removing the firm debris is often challenging and time‐consuming. Recently, effective ultrasonic cleaning for other medical devices has been reported. The aim of the present study was to clarify whether ultrasonic cleaning is effective in removing the debris on the insulation‐tipped diathermic (IT) knife‐2. Methods This study was an ex‐vivo experimental randomized study. A total of 40 IT knife‐2 knives with debris on their tip surfaces were prepared and randomly assigned to two groups (Group A and Group B). The knives in Group A were cleaned using the conventional scrubbing method for 30 s (conventional cleaning method), while those in Group B were cleaned using a combined method of scrubbing for 20 s and ultrasonic cleaning for 10 s (combined ultrasonic cleaning method). The tip electrode of the knife after cleaning was photographed under a microscope (40x). The 40 images of the knives were evaluated by independent three endoscopists and two clinical engineers using the five‐step evaluation criteria ranging from cleaning score 1 (dirty) to 5 (clean). Results The mean cleaning score of 3.78 (range: 2.33–4.67) in Group B was significantly higher than that of 1.68 (range: 1.00–2.83) in Group A. Conclusions The combined ultrasonic cleaning method could remove debris adhering to the IT knife‐2 more effectively than the conventional cleaning method. Ultrasonic cleaning may be applied for real‐world ESD.

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Endoscopic submucosal dissection using the Flex and the Dual knives

Cited by 46 publications

References 5 publications

Untutored Learning Curve to Establish Endoscopic Submucosal Dissection on Competence Level

Untutored Learning Curve to Establish Endoscopic Submucosal Dissection on Competence Level

What are the latest developments in colorectal endoscopic submucosal dissection?

Ultrasonic cleaning is effective in removing carbonized clots and tissue from the insulation‐tipped diathermic knife‐2

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