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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(01): E30-E34
DOI: 10.1055/s-0042-122335
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Waterjet submucosal dissection of porcine esophagus with the HybridKnife and ERBEJET 2 system: a pilot study

Daisuke Akutsu
1   Department of Gastroenterology, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan
,
Hideo Suzuki
2   Division of Endoscopy, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, Japan
,
Toshiaki Narasaka
1   Department of Gastroenterology, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan
,
Masahiko Terasaki
1   Department of Gastroenterology, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan
,
Tsuyoshi Kaneko
1   Department of Gastroenterology, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan
,
Hirofumi Matsui
1   Department of Gastroenterology, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan
,
Yuji Mizokami
2   Division of Endoscopy, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, Japan
,
Ichinosuke Hyodo
1   Department of Gastroenterology, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan
› Author Affiliations
Further Information

Publication History

submitted 28 June 2016

accepted after revision 24 October 2016

Publication Date:
20 January 2017 (online)

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Abstract

Background and study aims Esophageal endoscopic submucosal dissection (ESD) is technically difficult because of narrow working spaces and ease of perforation due to the lack of serosa. HybridKnife is a recently developed ESD device that is combined with the high pressure waterjet ERBEJET 2 system to lift mucosa. We hypothesized that this waterjet could make submucosal dissection safer and studied this in porcine esophagus.

Materials and methods Water pressures of 30 – 70 bar were tested to determine the appropriate pressure for waterjet ESD with HybridKnife (WJ-ESD) in one pig. WJ-ESD safety and completion were compared with those of conventional ESD using DualKnife (C-ESD) as a reference. Each of three virtual esophageal lesions in two pigs were resected alternatively using both methods from the lower to upper esophagus. For WJ-ESD, the submucosa, apart from hard fibrous tissues, was dissected using water pressure alone.

Results Using 50 bar of water pressure resulted in the best balance between proper dissection and view-disturbing water backflow. The dissection speeds for the lower, middle, and upper esophagus were 0.2, 0.9, and 0.2 cm2/min in 50 bar WJ-ESD and 1.1, 0.5, and 1.0 cm2/min in C-ESD, respectively. Minor bleeding was frequent in WJ-ESD, but was easily stopped by electrocoagulation with the same needle. No perforation was observed in either procedure. Thermal damage to dissected tissues appeared mild, and the extent of muscle injury was lower for WJ-ESD (4, 6, and 8 %) compared with C-ESD (14, 16, and 7 %).

Conclusions WJ-ESD could be completed safely for porcine esophagus with less damage to the muscle layer compared with C-ESD.

 

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