Endoscopic submucosal dissection using the Flush knife and the Flush knife BT

Endoscopic submucosal dissection (ESD) enables less invasive en bloc resection not only in the stomach but also in thinner-walled luminal organs such as the esophagus and colorectum. Although ESD using short needle knives provides safe and effective resection, there are certain challenges to overcome. The long procedure time, the high level of technical difficulty, and the high incidence of complications such as bleeding and perforation are some of the barriers to widespread practice of the technique. Because of the low hemostatic properties of needle knives, such as the standard Flush knife with water jet–emitting function, we have recently developed the ball-tip Flush knife (Flush knife BT). As predicted, the density of the current at the tip of the ball-tip Flush knife decreased compared with that of the standard Flush knife and hemostatic efficiency improved. Using either the standard Flush knife or the Flush knife BT in our unit, we have resected a total of 2112 early gastrointestinal lesions (stomach, 976; esophagus, 387; colorectum, 749) in 1820 patients with good results—total postoperative bleeding rate 1.7%, total perforation rate 1.5%, en bloc resection rate 99.6%, en bloc R0 resection rate 96.6%, and curative resection rate 87.5%. The standard Flush knife and the Flush knife BT are useful for technically and histopathologically appropriate submucosal dissection. The standard Flush knife is especially useful in difficult cases with a thin luminal wall, rich vessels, and severe fibrosis. The Flush knife BT can facilitate faster ESD with fewer complications, which is attributed to its improved operability and hemostatic properties.

Keywords: Stomach neoplasms, Esophageal neoplasms, Colorectal neoplasms, Endoscopic submucosal dissection (ESD), Flush knife, Flush knife BT