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Endoscopic Submucosal Dissection Using a Novel Versatile Knife: An Animal Feasibility Study (with Video).

Kwon CI, Kim G, Chung IK, Kim WH, Ko KH, Hong SP, Jeong S, Lee DH - Clin Endosc (2014)

Bottom Line: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives).The rate of adverse events and histological quality did not statistically differ between the modalities.ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

View Article: PubMed Central - PubMed

Affiliation: Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT

Background/aims: In order to reduce the procedure time and the number of accessory changes during endoscopic submucosal dissection (ESD), we developed a novel versatile knife, which has the combined advantages of several conventional knives. The aim of this study was to compare the efficacy, safety, and histological quality of ESD performed using this novel versatile knife and a combination of several conventional knives.

Methods: This was an in vivo animal study comparing two different modalities of ESD in mini-pigs. Completion time of each resection was documented, and the resected specimens were retrieved and evaluated for completeness. To assess the quality control of the procedures and adverse events, detailed histopathological examinations were performed.

Results: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives). All resections were completed as en bloc resections. There was no significant difference in procedure time between the 2 modalities (456 seconds vs. 355 seconds, p=0.258) and cutting speed (1.983 mm(2)/sec vs. 1.57 mm(2)/sec, p=1.000). The rate of adverse events and histological quality did not statistically differ between the modalities.

Conclusions: ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

No MeSH data available.


Related in: MedlinePlus

Endoscopic submucosal dissection (ESD) procedures in the animal model. (A) Markings were made with the tip of the Optimos knife (Taewoong Medical) in the soft coagulation mode. (B) The mixed solution was repeatedly injected into the submucosal layer. (C-E) The tip of the Optimos knife was used to make the incision along the markings, using the endocut mode. (F-J) Submucosal dissection was carried out using the forced coagulation mode. The vessel was coagulated by the hooking method using the soft coagulation mode and cut using the endocut mode. (K, L) The distal remnant mucosal area was cut with the hooking method. (M-O) The knife can coagulate the small vessels of a ramified vascular network in a forced coagulation mode. (P, Q) The water injection system was used to keep enough fluid in the submucosa for continuous submucosal dissection. (R, S) The Coagrasper forceps were used to control major bleeding from large vessels, using the soft coagulation mode. (T) The post-ESD ulcers were shown to prevent bleeding afterward. (U-X) Three conventional knives (the IT-2, the Hook Knife, and the Dual knife) were used for ESD in the combination knives group.
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Figure 2: Endoscopic submucosal dissection (ESD) procedures in the animal model. (A) Markings were made with the tip of the Optimos knife (Taewoong Medical) in the soft coagulation mode. (B) The mixed solution was repeatedly injected into the submucosal layer. (C-E) The tip of the Optimos knife was used to make the incision along the markings, using the endocut mode. (F-J) Submucosal dissection was carried out using the forced coagulation mode. The vessel was coagulated by the hooking method using the soft coagulation mode and cut using the endocut mode. (K, L) The distal remnant mucosal area was cut with the hooking method. (M-O) The knife can coagulate the small vessels of a ramified vascular network in a forced coagulation mode. (P, Q) The water injection system was used to keep enough fluid in the submucosa for continuous submucosal dissection. (R, S) The Coagrasper forceps were used to control major bleeding from large vessels, using the soft coagulation mode. (T) The post-ESD ulcers were shown to prevent bleeding afterward. (U-X) Three conventional knives (the IT-2, the Hook Knife, and the Dual knife) were used for ESD in the combination knives group.

Mentions: Two experienced endoscopists (IKC and CIK) performed all procedures (Supplementary Videos 2,3 [available online at http://www.e-ce.org/]); both had performed many ESDs in clinical settings and conducted several teaching programs for ex vivo and in vivo ESD training. All markings on the target mucosa were made circumferentially with the tip of the Optimos knife in the soft coagulation mode and were 2.5×2.5 cm wide (to make 3×3 cm wide resected specimens), with 2 to 4 mm intervals between each marked dot (Fig. 2A).


Endoscopic Submucosal Dissection Using a Novel Versatile Knife: An Animal Feasibility Study (with Video).

Kwon CI, Kim G, Chung IK, Kim WH, Ko KH, Hong SP, Jeong S, Lee DH - Clin Endosc (2014)

Endoscopic submucosal dissection (ESD) procedures in the animal model. (A) Markings were made with the tip of the Optimos knife (Taewoong Medical) in the soft coagulation mode. (B) The mixed solution was repeatedly injected into the submucosal layer. (C-E) The tip of the Optimos knife was used to make the incision along the markings, using the endocut mode. (F-J) Submucosal dissection was carried out using the forced coagulation mode. The vessel was coagulated by the hooking method using the soft coagulation mode and cut using the endocut mode. (K, L) The distal remnant mucosal area was cut with the hooking method. (M-O) The knife can coagulate the small vessels of a ramified vascular network in a forced coagulation mode. (P, Q) The water injection system was used to keep enough fluid in the submucosa for continuous submucosal dissection. (R, S) The Coagrasper forceps were used to control major bleeding from large vessels, using the soft coagulation mode. (T) The post-ESD ulcers were shown to prevent bleeding afterward. (U-X) Three conventional knives (the IT-2, the Hook Knife, and the Dual knife) were used for ESD in the combination knives group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260103&req=5

Figure 2: Endoscopic submucosal dissection (ESD) procedures in the animal model. (A) Markings were made with the tip of the Optimos knife (Taewoong Medical) in the soft coagulation mode. (B) The mixed solution was repeatedly injected into the submucosal layer. (C-E) The tip of the Optimos knife was used to make the incision along the markings, using the endocut mode. (F-J) Submucosal dissection was carried out using the forced coagulation mode. The vessel was coagulated by the hooking method using the soft coagulation mode and cut using the endocut mode. (K, L) The distal remnant mucosal area was cut with the hooking method. (M-O) The knife can coagulate the small vessels of a ramified vascular network in a forced coagulation mode. (P, Q) The water injection system was used to keep enough fluid in the submucosa for continuous submucosal dissection. (R, S) The Coagrasper forceps were used to control major bleeding from large vessels, using the soft coagulation mode. (T) The post-ESD ulcers were shown to prevent bleeding afterward. (U-X) Three conventional knives (the IT-2, the Hook Knife, and the Dual knife) were used for ESD in the combination knives group.
Mentions: Two experienced endoscopists (IKC and CIK) performed all procedures (Supplementary Videos 2,3 [available online at http://www.e-ce.org/]); both had performed many ESDs in clinical settings and conducted several teaching programs for ex vivo and in vivo ESD training. All markings on the target mucosa were made circumferentially with the tip of the Optimos knife in the soft coagulation mode and were 2.5×2.5 cm wide (to make 3×3 cm wide resected specimens), with 2 to 4 mm intervals between each marked dot (Fig. 2A).

Bottom Line: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives).The rate of adverse events and histological quality did not statistically differ between the modalities.ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

View Article: PubMed Central - PubMed

Affiliation: Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT

Background/aims: In order to reduce the procedure time and the number of accessory changes during endoscopic submucosal dissection (ESD), we developed a novel versatile knife, which has the combined advantages of several conventional knives. The aim of this study was to compare the efficacy, safety, and histological quality of ESD performed using this novel versatile knife and a combination of several conventional knives.

Methods: This was an in vivo animal study comparing two different modalities of ESD in mini-pigs. Completion time of each resection was documented, and the resected specimens were retrieved and evaluated for completeness. To assess the quality control of the procedures and adverse events, detailed histopathological examinations were performed.

Results: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives). All resections were completed as en bloc resections. There was no significant difference in procedure time between the 2 modalities (456 seconds vs. 355 seconds, p=0.258) and cutting speed (1.983 mm(2)/sec vs. 1.57 mm(2)/sec, p=1.000). The rate of adverse events and histological quality did not statistically differ between the modalities.

Conclusions: ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

No MeSH data available.


Related in: MedlinePlus