ENDOSCOPIC SUBMUCOSAL DISSECTION USING IT-KNIFE NANO

Introduction: Recently a shorter and slimmer IT-knife, IT-nano, was developed for endoscopic submucosal dissection (ESD). To our best knowledge, there are no descriptions of prospective studies evaluating this device. Aims & Methods: We evaluated prospectively, the efficacy and safety of IT-nano. Consecutive patients with esophageal or colorectal lesions prone for ESD were invited to participate and gave written inform consent. Follow-up endoscopies were performed 2 months after ESD and subsequently planned for each 6 – 12 months, according to pathology. Results: Seventeen patients (10 female) were included, with median age of 67 years (range 49 – 89). Lesions were located in the esophagus (n = 1), ascending colon (n = 3), transverse colon (n = 1), sigmoid colon (n = 6), and rectum (n = 6). Macroscopically, 2 lesions were type Ip, 4 Is, 8 IIa, 1 IIab, 1 IIa-c. There was no visible lesion in a case of Barrett's esophagus with previous resected adenocarcinoma and dysplasia on follow-up. En bloc resection and R0 resection were achieved in 15 and 14 cases, respectively. Resected tumor size ranged between 22 – 77 mm (median 40 ± 15 mm). Pathologicaly, 2 lesions corresponded to invasive denaocarcinoma (1 with < 500 µm submucosal invasion), 1 to intramucosal adenocarcinoma, 6 to high-grade dysplasia and 8 to low-grade dysplasia. There were no cases of perforation or major bleeding. Fourteen procedures were performed in an outpatient setting. The remaining patients were discharged within 7 days. Two patients needed surgery after the ESD: 1 due to poor central lifting with incomplete resection and the other because of deep submucosal invasion (R0). One patient developed esophageal stricture that was treated conservatively. There were no cases of recurrence in the short term follow-up. Conclusión: IT-nano enabled accurate and safe ESD even in large lesions and in organs more difficult and prone to complications, such as esophagus and colon. Larger studies are needed to evaluate the definitive role of IT-nano on ESD.