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DOI: 10.1055/a-2316-9305
Automatic water irrigation synchronized with the electrosurgical unit: Bubble-free underwater endoscopic submucosal dissection
The water pressure method is a underwater ESD technique, which facilitates direct visualization of the submucosa using a water stream through the waterjet channel of an endoscope [1]. This method significantly improves endoscopic exposure in difficult conditions such as the initiation of the submucosal dissection, dissection in a narrow space, and dissection of fibrotic tissue, and has been reported as useful for technically challenging ESD [2] [3] [4]. However, there is a problem in that the heat generated by the activation of the electrosurgical device at the lesion site creates bubbles in the water that often obstruct endoscopic visualization. In addition, especially when a tapered hood attachment is used, those bubbles are often trapped inside the attachment and are difficult to remove.
To solve this drawback, we have developed a modified underwater ESD technique that uses a water irrigation pump controlled synchronously with the activation from the electrosurgical unit. An endoscopic water irrigation pump (EIP2; Erbe, Tübingen, Germany) ([Fig. 1]) is connected to the waterjet channel by a dedicated tube. This EIP2 pump also has a wired connection to the VIO3 electrosurgical unit (Erbe), that enables simultaneous activation of the pump and the VIO3 ([Fig. 2],[Fig. 3]). Water irrigation is done automatically when incision or coagulation currents are activated, thereby removing any generated bubbles before they can be trapped in the hood attachment and enabling a continuously clear view for ESD performance ([Fig. 4], [Video 1]). We use the EIP2 with an output power of 50%–60%, but we recommend adjusting the power on a case-by case basis.
Qualität:
The bubbles generated during underwater ESD compromise endoscopic visibility, which may lead to loss of procedural precision. Our new technique, named “bubble-free underwater ESD,” can be a simple and practical solution.
Endoscopy_UCTN_Code_TTT_1AQ_2AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
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Publikationsverlauf
Artikel online veröffentlicht:
05. Juni 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Yahagi N, Nishizawa T, Sasaki M. et al. Water pressure method for duodenal endoscopic submucosal dissection. Endoscopy 2017; 49: E227-E228
- 2 Kato M, Takatori Y, Sasaki M.. et al. Water pressure method for duodenal endoscopic submucosal dissection (with video). Gastrointest Endosc 2021; 93: 942-949
- 3 Masunaga T, Kato M, Sasaki M. et al. Colorectal endoscopic submucosal dissection using the water pressure method for diverticulum-associated lesions: A case series study (with video). Endosc Int Open 2023; 11: E305-E314
- 4 Miyazaki K, Kato M, Takatori Y. et al. A successful case of endoscopic submucosal dissection using the water pressure method for hypopharyngeal carcinoma with severe fibrosis. Endoscopy 2023; 55: E721-E722