Endoscopic submucosal dissection of colorectal tumors using a novel monopolar scissor‐type knife “<scp>SB</scp> Knife Jr.2”

Tamaru, Yuzuru; Kuwai, Toshio; Ishaq, Sauid

doi:10.1111/den.13478

Cited by 8 publications

(7 citation statements)

References 6 publications

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“…A water-jet fluid solution was typically used with a mechanical water pump (OFP-2; Olympus). A scissor-type knife (Stag-Beetle Knife Jr or Jr 2 [SB Knife Jr (5)/Jr 2 (13); Sumitomo Bakelite, Tokyo, Japan]) was used during the ESD procedures, and which was also used for endoscopic hemostasis in bleeding situations. If repeated coagulation was required, hemostatic forceps (Coagrasper [FD410LR]; Olympus, or RAICHO2; Kaneka Medics, Tokyo, Japan) were used.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of a Traction Device for Endoscopic Submucosal Dissection Using a Scissor-Type Knife: A Randomized Controlled Trial

et al. 2022

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INTRODUCTION:Although safe, colorectal endoscopic submucosal dissection (ESD) using a scissor-type knife has a slow resection speed. We aimed to evaluate the efficacy of a traction device to hasten the resection speed.METHODS:This multicenter randomized controlled trial was conducted at 3 Japanese institutions. Patients with a 20–50-mm superficial colorectal tumor were enrolled and randomly assigned to a conventional-ESD (C-ESD) group or a traction-assisted ESD (T-ESD) group. The primary outcome was the resection speed.RESULTS:The C-ESD and T-ESD groups comprised 49 and 48 patients, respectively. Although the mean resection speed was not significantly different in the entire cohort between the groups (23.7 vs 25.6 mm2/min, respectively; P = 0.43), it was significantly faster with T-ESD than with C-ESD at the cecum (32.4 vs 16.7 mm2/min, respectively; P = 0.02). The mean resection speed of tumors ≥30 mm tended to be faster by T-ESD than by C-ESD (34.6 vs 27.8 mm2/min, respectively; P = 0.054). The mean procedure time of T-ESD was significantly shorter than that of C-ESD (47.3 vs 62.3 minutes, respectively; P = 0.03). The en bloc (100% vs 100%), complete (98.0% vs 97.9%), and curative resection (93.9% vs 91.7%) rates were similar between the 2 groups. Perforation and delayed hemorrhage occurred in only 1 patient each in the T-ESD group.DISCUSSION:Although the resection rates were sufficiently high and adverse event rates were extremely low in both the groups, the use of a traction device for ESD in the proximal colon and for large lesions may increase the resection speed.

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Section: Methodsmentioning

confidence: 99%

Efficacy of a Traction Device for Endoscopic Submucosal Dissection Using a Scissor-Type Knife: A Randomized Controlled Trial

et al. 2022

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“…The SB Knife Jr was launched in 2010 [10,11] . Regarding the structure of the SB Knife Jr, the small tapered and curved tip design with superior rotation allows accurate manipulation within the endoscope visual field to minimize unintentional muscular layer injury.…”

Section: The Sb Knife Jrmentioning

confidence: 99%

SB Knife Jr: characteristics and tips on how to use

Kuwai¹,

Tamaru²,

Kusunoki³

et al. 2022

MIS

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Widespread adoption of colorectal endoscopic submucosal dissection (ESD) in clinical practice is lagging despite the peer evidence that it permits en bloc resection of large lesions that can be curative and facilitate pathological staging, thereby improving management. Limited adoption of colorectal ESD is likely due to technical challenges and a steep learning curve. Most conventional ESD devices are used without fixing the target, making them difficult to maneuver and thus creating a potential risk of perforation. Comparatively, a scissor-type knife, such as the SB Knife Jr, enables grasping of the target tissue, facilitating controlled dissection of tissue being held between the blades. This potentially prevents unexpected muscular layer injury. Colorectal ESD with the SB Knife Jr does not require complex endoscopic maneuvering or advanced skills for safe ESD. Since the incision and dissection procedure using the SB Knife Jr is different from that of conventional ESD knives, familiarization with its features is vital. In this review, we focus on the use of the SB Knife Jr for colorectal ESD. The basic colorectal ESD procedure using the SB Knife Jr consists of grasping, pulling, and cutting. By repeating these steps, circumferential incision, submucosal dissection, and hemostasis can be performed with a single device. For incision and dissection, a circumferential mucosal incision is performed similar to “cutting paper”. Submucosal dissection is performed with the image of “connecting the dots at the appropriate dissection depth”. The SB Knife Jr is useful as a secondary device in challenging ESD procedures, and surgeons should master its use.

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“…– Advantages: Ability to grasp away from the submucosal plane and check position before cutting improves safety, good for more technically challenging anatomy for example, oesophagus and colorectal as well as gastric. 11 – 16 …”

Section: Knivesmentioning

confidence: 99%

Endoscopic submucosal dissection: an update on tools and accessories

Harlow

Sivananthan

Ayaru

et al. 2020

Clin Med Insights Gastroenterol

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Endoscopic submucosal dissection (ESD) is a minimally invasive therapeutic procedure to remove larger polyps or early non-metastatic lesions. It has long been used in Asia, but is now fast growing in popularity in the West. There are multiple challenges faced by ESD practitioners. While the practice of ESD in gastric lesions is relatively well established, the oesophagus with its narrow lumen and challenging workspace, and the colon with its tortuous course and folds are more challenging frontiers. The nature of performing a procedure endoscopically means that conventional methods offer no mechanism for providing counter-traction while performing dissection, impeding visibility and increasing the rate of complications. There are a multitude of tools available to those performing ESD for the different stages of the procedure. This article reviews the accessories currently used in regular ESD practice including the knives used to cut and dissect lesions, the cap and hood devices used to improve visibility and safety, injection fluids to lift the submucosal plane, haemostatic devices, generators, and finally, emerging traction apparatus. There is some evidence behind the use of these tools, however, ESD remains the domain of a small number of practitioners and the practice relies heavily on expert experience. Evolution of the ESD toolbox will make the procedure more accessible to more endoscopists, which in turn will drive the development of a more substantial evidence base to evaluate efficacy and safety of the multitude of tools.

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Endoscopic submucosal dissection of colorectal tumors using a novel monopolar scissor‐type knife “SB Knife Jr.2”

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Cited by 8 publications

References 6 publications

Efficacy of a Traction Device for Endoscopic Submucosal Dissection Using a Scissor-Type Knife: A Randomized Controlled Trial

Efficacy of a Traction Device for Endoscopic Submucosal Dissection Using a Scissor-Type Knife: A Randomized Controlled Trial

SB Knife Jr: characteristics and tips on how to use

Endoscopic submucosal dissection: an update on tools and accessories

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