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
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？min [41, 78] versus 74.0 [57, 90]？min; , Hazard Ratio HR: 0.53; 95% CI (0.29–0.97)). 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 (0.04–0.66)). 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 [1–5] 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 [7–9], 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？mm and smaller than
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