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DOI: 10.1055/s-2006-925320
© Georg Thieme Verlag KG Stuttgart · New York
Endoscopic submucosal dissection using a novel irrigation wiper-knife
Publication History
Publication Date:
04 July 2007 (online)
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Endoscopic submucosal dissection techniques require special skills and the procedure can be very prolonged [1] [2]. In response these drawbacks, we have designed a new dissection knife, the “wiper-knife”, which simplifies the procedure.
We recently developed a hood-knife that facilitates endoscopic submucosal dissection by sliding the hood-knife with coagulation current along the muscle layer [2]. However, we considered that it was essential to be able to perform endoscopic submucosal dissection more mechanically. The wiper-knife was made by installing a needle-knife in exchange for the snare forceps we used in the hood-knife. The needle-knife was crossed by and fixed with a handling wire, which was inserted through tubes at either side of the hood.
Figure 1 The irrigation wiper-knife. a The irrigation tube (4) and needle-knife (1) were glued to the exterior surface over the hole, but only the needle-knife was intersected by and fixed with the handling wire (2). b The schematic representation shows more clearly how the needle-knife moves like a windshield wiper (double-headed red arrow).
The endoscopic submucosal dissection procedure using the wiper-knife is carried out as follows (Figure [2]): a grasping forceps is passed through an accessory channel and used to push the lesion away from the muscle layer; submucosal exfoliation is then performed by moving the wiper-knife like a windshield wiper with coagulation current on the muscle layer to separate the submucosa from the muscle layer. We resected three specimens in animal models (pigs) using this wiper-knife. The average diameter of the resected specimens was 30 mm.
Figure 2 Schematic representation of the endoscopic submucosal dissection procedure using the wiper-knife.
Endoscopic submucosal dissection can be safely and easily carried out under direct vision using this method. Another advantage of the wiper-knife is that endoscopic submucosal dissection and endoscopic hemostasis can be carried out while simultaneously applying adequate irrigation [2] [3] [4] [5] [6].
Endoscopy_UCTN_Code_TTT_1AO_2AG
References
- 1 Muto M, Miyamoto S, Hosokawa A. et al . Endoscopic mucosal resection in the stomach using the insulated-tip needle-knife. Endoscopy. 2005; 37 178-182
- 2 Kume K, Yamasaki M, Kanda K. et al . Endoscopic submucosal dissection using a novel irrigation hood-knife. Endoscopy. 2005; 37 1030-1031
- 3 Kume K, Yamasaki M, Yamasaki T. et al . Endoscopic hemostatic treatment under irrigation for upper GI hemorrhage: a comparison of one third and total circumference transparent end hoods. Gastrointest Endosc. 2004; 59 712-716
- 4 Kume K, Yoshikawa I, Otsuki M. Endoscopic treatment of upper GI hemorrhage with a novel irrigating hood attached to the endoscope. Gastrointest Endosc. 2003; 57 732-735
- 5 Kume K, Yamasaki M, Kubo K. et al . EMR of upper GI lesions when using a novel soft, irrigation, prelooped hood. Gastrointest Endosc. 2004; 60 124-128
- 6 Kume K, Yamasaki M, Kanda K. et al . Endoscopic procedure under irrigation. Dig Endosc. 2005; 17 241-245
M. Otsuki, M. D.
Third Department of Internal Medicine, School of Medicine
University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu 807-8555Japan
Fax: +81-93-692-0107
Email: mac-otsk@med.uoeh-u.ac.jp