Endoscopic submucosal dissection using a novel irrigation wiper-knife

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].

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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