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USE OF SHORT NEEDLE KNIFE FOR ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION
Author(s) -
Toyonaga Takashi,
Nishino Eisei,
Hirooka Takashi,
Dozaiku Toshio,
Sugiyama Takeshi,
Iwata Yoshinori,
Ono Wataru,
Ueda Chie,
Tomita Masafumi,
Hirooka Tomoomi,
Makimoto Shinichiro,
Hayashibe Akira,
Sonomura Tetuo
Publication year - 2005
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2005.00534.x
Subject(s) - medicine , endoscopic submucosal dissection , surgery , dissection (medical) , lesion , esophagus , endoscopic mucosal resection , radiology , endoscopy
Background: The emergence of endoscopic submucosal dissection (ESD) has enabled en bloc resection of lesions, which were conventionally difficult. However, ESD has problems of technical difficulty and high incidence of complications. In order to improve the procedure of marking and submucosal dissection in the esophagus, we modified and adjusted the standard needle knife to a short needle knife having a tip portion with a projection length of 1.5 mm. Methods: We treated 20 esophageal lesions with ESD using the short needle knife. We marked around the lesion with the short needle knife and performed mucosal incision of the entire circumference with a needle knife and an IT knife, then dissected the submucosal layer with the short needle knife. A Hook knife was also used in situations where muscular layers were located in the front‐view Results: Complete en bloc resection was performed in all 20 cases. The diameter of lesions ranged from 3 to 65 mm (median, 20 mm), and that of resected specimens ranged from 28 to 90 mm (median, 47 mm). Submucosal dissection was completed with the short needle knife alone in 13 cases in 20 (65%), and in seven cases (35%), in combination with so‐called Hook knife. The procedure was complicated in one patient with mediastinal emphysema. Conclusions: The short needle knife proved to be useful and safe in clear marking and submucosal dissection of esophageal lesions. It allows greater flexibility in the angle of insertion, and enables more effective and safer procedures because its full length can be inserted into the submucosa and fixed.