Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country

Abstract

Background: Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. Objective: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with highpressure water jet and to compare with standard ESD. Material and methods: We performed a prospective nonsurvival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard). Results: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 ± 21.4 minutes vs. 68.7 ± 33.5 minutes; p = 0.009 and velocity: 20.8 ± 9.2 mm 2 / min vs. 14.3 ± 9.3 mm 2 /min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 ± 15.68 to 28.18 ± 20.07 mm 2 /min; p = 0.615 and standard: From 6.4 ± 0.3 to 19.48 ± 19.21 mm 2 /min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). Conclusion: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybridknife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.

Endoscopic submucosal dissection of endobronchial leiomyoma with a hybrid knife in an adolescent patient: a case report

“…The hybrid knife is a novel tool that integrates a high-pressure water jet with an electrocautery knife. This combination renders ESD more convenient because the same device can be used for submucosal injections, lesion dissection, and hemostasis ( 14 ). ESD can effectively expose the tumor base for a more comprehensive resection.…”

“…Endoscopic submucosal dissection (ESD) is performed for submucosal tumors within the gastrointestinal tract, often achieving curative results ( 9 – 13 ). The hybrid knife, with multifunctional capabilities, such as circumferential dissection, submucosal injections, dissection, and hemostasis ( 14 , 15 ), has expedited ESD procedures ( 14 ). It can also be used to treat recurrent benign tracheal tumors ( 16 ).…”

Conventional versus hybrid knife endoscopic submucosal dissection in large colorectal laterally spreading tumors: A propensity score analysis

“…The results of the present study were comparable with a prospective study of 50 experimental gastric ESDs, with a hybrid knife, in animals. [ 8 ] The resection speed in the HK group was significantly faster than that in the C-group. Several possibilities might explain why the hybrid knife achieved faster speed.…”

“…[ 6 ] A hybrid knife is a multifunctional device that combines an electrocautery needle and an ultrafine high-pressure fluid jet system in a single instrument, which is reported to reduce rectal ESD difficulties and procedure time. [ 6 7 8 ] Second, the importance of complete resection for superficial CRC cannot be underestimated, as it is imperative for the evaluation of histopathology, resection margins, and submucosal invasion. The United States National Comprehensive Cancer Network (NCNN) guidelines recommend that additional surgery is required for malignant colorectal polyps after piecemeal resection.…”

Precision Endoscopy in Peroral Myotomies for Motility Disorders of the Upper Gastrointestinal Tract: Current Insights and Prospective Avenues—A Comprehensive Review

“…Then, tunneling is undertaken on both sides of the septum. The commonly employed knife is the Hybrid knife (ERBE USA Inc., Marietta, GA, USA) [129]. The tunnel is extended caudally on each side, terminating 1-2 cm below the base of the diverticulum.…”