%0 Journal Article
%T An Electrosurgical Endoknife with a Water-Jet Function (Flushknife) Proves Its Merits in Colorectal Endoscopic Submucosal Dissection Especially for the Cases Which Should Be Removed En Bloc
%A Yoji Takeuchi
%A Toshio Shimokawa
%A Ryu Ishihara
%A Hiroyasu Iishi
%A Noboru Hanaoka
%A Koji Higashino
%A Noriya Uedo
%J Gastroenterology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/530123
%X Background. Previously, we reported that the Flushknife (electrosurgical endoknife with a water-jet function) could reduce the operation time of colorectal endoscopic submucosal dissection (ESD) however, suitable situation for the Flushknife was obscure. This subgroup analysis of a prospective randomized controlled trial was aimed to investigate the suitable situation for the Flushknife. Methods. A total of 48 superficial colorectal neoplasms that underwent ESD using either the Flexknife or the Flushknife in a referral center were enrolled. The differences of operation time between the Flexknife and the Flushknife groups in each subgroup (tumor size, location, and macroscopic type) were analyzed. Results. Median (95% CI) operation time calculated using survival curves was significantly shorter in the Flushknife group than in the Flexknife group (55.5£żmin [41, 78] versus 74.0 [57, 90]£żmin; , Hazard Ratio HR: 0.53; 95% CI (0.29¨C0.97)). In particular, the HR in patients with laterally spreading tumors-nongranular type (LST-NG) in the Flushknife group was significantly smaller than in the Flexknife group (HR: 0.165 0.17; 95% CI (0.04¨C0.66)). There was a trend of decreasing HRs according to larger lesion size. Conclusions. The Flushknife proved its merits in colorectal ESD especially for the lesions which should be removed en bloc (LST-NG and large lesion). 1. Introduction Endoscopic submucosal dissection (ESD) is one of the standard treatments for large upper gastrointestinal superficial neoplasms in Japan and South Korea [1¨C5] because of its high en bloc resection (entire tumor resection in one piece) rate. ESD is also considered as a promising procedure in Western countries [6]. Although there are some reports on ESD for colorectal superficial neoplasms [7¨C9], ESD has not been a standard therapy for large colorectal superficial neoplasms, even in Japan. The reason is that it is time consuming, technically difficult, and related to a higher incidence of complications (perforation and bleeding) than conventional endoscopic mucosal resection (EMR) [10]. Flushknife (DK2618JN15, Fujifilm Medical, Tokyo, Japan) is a short needle electrosurgical endo-knife combined with a water-jet function (Figure 1(a)) [11]. We have reported that the Flushknife could reduce the operation time of colorectal ESD for patients with large colorectal superficial neoplasms [12], compared with a standard electrosurgical endo-knife (Flexknife; KD-630L, Olympus Medical Systems, Tokyo, Japan, Figure 1(b)) [13, 14]. In the study, we enrolled lesions larger than 20£żmm and smaller than
%U http://www.hindawi.com/journals/grp/2013/530123/