Efficacy of a Novel Narrow Knife with Water Jet Function for Colorectal Endoscopic Submucosal Dissection

Yoshida, Naohisa; Toyonaga, Takashi; Murakami, Takaaki; Hirose, Ryohei; Ogiso, Kiyoshi; Inada, Yutaka; Rani, Rafiz Abdul; Naito, Yuji; Kishimoto, Mitsuo; Ohara, Yoshiko; Azuma, Takeshi; Itoh, Yoshito

doi:10.1155/2017/5897369

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…In our hospital, we mainly use the FlushKnife BT-S for colorectal ESD. This knife has some merits in terms of its water jet function, which means that endoscopists can inject normal saline into the submucosal layer using the knife without the need to exchange it with other needles 8 9 10 .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of “Nelaton Attachment” for endoscopic submucosal dissection of colorectal neoplasms

et al. 2019

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Background and study aims Although colorectal endoscopic submucosal dissection (ESD) has enabled high en bloc resection rates regardless of tumor size, colorectal ESD is still a challenging procedure. We developed a novel device called the Nelaton Attachment, which allows endoscopists to manipulate the ESD knives using two fingers of their left hand while holding the endoscope with their right hand. We retrospectively investigated the efficacy and safety of the Nelaton Attachment for colorectal ESD. We compared efficacy and safety between Nelaton Attachment and non-Nelaton Attachment groups, and also conducted an ex vivo experiment to evaluate the effect of the Nelaton Attachment. Patients and methods We retrospectively reviewed 36 consecutive patients with 37 colorectal tumors who had undergone ESD at Kishiwada Tokushukai Hospital and Naritatomisato Tokushukai Hospital between April 2016 and September 2018. The Nelaton Attachment was used for 22 of the 37 colorectal ESDs. In the ex vivo experiment, endoscopists inserted and withdrew an ESD knife 2 cm using two fingers of their left hand with and without the Nelaton Attachment. Results Median procedure time was significantly shorter in the Nelaton Attachment group (38 min [range 6 – 195 min]) compared to the non-Nelaton Attachment group (75 min [range 17 – 198 min]; P = 0.030). Median time to complete the ex vivo experiment five times was significantly faster with the Nelaton Attachment than without the Nelaton Attachment (P = 0.001). Conclusions Use of the Nelaton Attachment for colorectal ESD is feasible and safe, and may facilitate colorectal ESD procedures.

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Section: Discussionmentioning

confidence: 99%

Usefulness of “Nelaton Attachment” for endoscopic submucosal dissection of colorectal neoplasms

et al. 2019

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“…Our routine ESD procedure with non-PCM was described previously 6 9 . In brief, it was performed with a short-tipped ESD knife such as the Flush Knife BT-S 2.0 mm (Fujifilm Medical Co., Tokyo, Japan) and a grasping scissor knife such as the Clutch Cutter 3.5 mm (Fujifilm Medical Co.) 17 18 . The Clutch Cutter was used only in challenging cases such as those involving several thick vessels and with poor operability.…”

Section: Methodsmentioning

confidence: 99%

The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection

et al. 2018

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Background and study aims Severe fibrosis poses a challenge in colorectal endoscopic submucosal dissection (ESD). Recently, the pocket-creation method (PCM) has been developed for overcoming various difficulties of ESD. A specific tapered hood is used for adequate traction in the PCM, and endoscopic operability becomes stable in the pocket. In this study, we investigated the efficacy of the PCM in ESD for cases with severe fibrosis. Patients and methods We retrospectively reviewed 1000 consecutive colorectal ESD cases (April 2006 to January 2017). Since 2016, the PCM was performed in 58 cases. The indications for ESD included (1) tumors ≥ 20 mm in size diagnosed as intramucosal cancer or high-grade dysplasia and part of T1a cancer using magnifying endoscopic examinations and (2) tumors that appeared impossible to resect with endoscopic mucosal resection because of suspected fibrosis. We identified 120 cases with severe fibrosis and compared them to cases without severe fibrosis. Additionally, the 120 severe fibrosis cases were divided into the PCM and non-PCM groups. En bloc resection, procedure time, discontinuation, and complications were analyzed between these 2 groups. Results Among all 1000 ESDs, severe fibrosis and discontinuation rates were 12.0 % (120 cases) and 1.8 % (18 cases), respectively. Regarding the comparison between cases with severe fibrosis and with no severe fibrosis, there were significant differences about en bloc resection rate (78.3 % vs. 95.7 %, P < 0.001), discontinuance rate (12.5 % vs. 0.3 %, P < 0.001), and perforation rate (8.3 % vs. 2.6 %, P = 0.001). Among the 120 cases with severe fibrosis, 21 and 99 cases were in the PCM and non-PCM groups, respectively. The PCM group had a higher en bloc resection rate (95.2 vs. 74.7, P = 0.03), a shorter mean procedure time (min) (79.6 ± 26.5 vs. 118.8 ± 71.0, P = 0.001), and no cases of discontinuation. An analysis of the interobserver agreement for the diagnosis of severe fibrosis among the 3 endoscopists showed kappa values of > 0.6. Conclusions In cases with severe fibrosis, the PCM with ESD improved en bloc resection rates and shortened the procedure time compared to the conventional non-PCM method. Additionally, the PCM reduced the discontinuation rate.

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“…The flush knife BT-S is 200 mm longer than the flush knife BT, making it suitable for the longer colonoscopes used in the West. 15 Hybrid Knife (ERBE; ►Fig. 2B)…”

Section: Flush Knifementioning

confidence: 99%

Knives in Third Space

Mukkada

Mathew

2022

Journal of Digestive Endoscopy

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Endoscopic mucosal resection (EMR) has always been done with a snare. The maximum diameter of the snare is usually 2 cm and the largest lesion that can be removed in one piece is usually maximum of 2 cm. In EMR, after the elevation of the submucosa, snares are used for the resection of the mucosal lesion; however, for endoscopic submucosal dissection (ESD), special knives are required, which have various uses in different areas of the gastrointestinal tract. ESD knives have developed and evolved over the past 30 years allowing it to be performed safely. It allows very precise cutting of the mucosa as well as dissection of the submucosal tissue planes. This review discusses some of the more commonly used knives.

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Efficacy of a Novel Narrow Knife with Water Jet Function for Colorectal Endoscopic Submucosal Dissection

Cited by 7 publications

References 11 publications

Usefulness of “Nelaton Attachment” for endoscopic submucosal dissection of colorectal neoplasms

Usefulness of “Nelaton Attachment” for endoscopic submucosal dissection of colorectal neoplasms

The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection

Knives in Third Space

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