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Introducing the newly developed SB Knife Jr 2: enhancing creative endoscopic submucosal dissection
Endoscopic submucosal dissection (ESD) using a scissor-type knife has notable benefits     . Its design and rotatability allow increased stability and accurate control of dissection. Additionally, it is useful for accurate vessel sealing and hemostasis. The SB Knife Jr (Sumitomo Bakelite, Tokyo, Japan), developed in 2011, is available worldwide . However, there are some issues related to its use, such as poor repetitive incisional performance, interference with the hood, and cumbersome operation by the assistant. The latest version, the SB Knife Jr 2 (Sumitomo Bakelite), is, like the conventional model, a fully rotatable scissor-type knife with insulated sides to avoid muscular injury, but it also has features addressing the above-mentioned issues, thereby enhancing the safety of ESD. New features of the SB Knife Jr 2 relate to (1) the knife structure, to improve the ability to grasp tissue; (2) the scissor structure, to avoid interference with the hood; (3) the coating of the knife, to improve the repetitive incision ability; and (4) the new rotation operation part ([Fig. 1]). We demonstrate two ESD procedures using the SB Knife Jr 2 ([Video 1]).
Video 1 Endoscopic submucosal dissection using an SB Knife Jr 2 to treat neoplasms in the gastric remnant and duodenum.
The first case was a flat tumor (10 × 15 mm) in the greater curvature of the gastric remnant ([Fig. 2 a], [Fig. 2 b]). We started ESD using a tip-type knife (Dual knife; Olympus, Tokyo, Japan); however, massive bleeding occurred, and endoscopic maneuverability was poor. As the dual knife was seen positioned vertically to the muscle layer, we switched to an SB Knife Jr 2, which allowed an approach parallel to the muscle layer. In addition, vessels were successfully sealed by grasping, thereby decreasing the chances of bleeding ([Fig. 2 c], [Fig. 2 d]).
The second case was a 40 × 35-mm pedunculated duodenal tumor ([Fig. 3 a], [Fig. 3 b], [Fig. 3 c]). The stalk of the tumor was short, and its head was wide. Endoscopic maneuverability was poor because of the duodenal anatomy. Here, ESD using an SB Knife Jr 2 was performed to avoid incomplete resection ([Fig. 3 d]).
Both treatments were successful without any adverse events.
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19 November 2020 (online)
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