THE EFFECTIVENESS OF GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION USING HYBRIDKNIFE<sup>®</sup> WITH THE ERBEJET 2 SYSTEM

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  • 早期胃癌及び胃腺腫に対するHybridKnife<sup>®</sup>を用いた内視鏡的粘膜下層剥離術の有用性の検討

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<p>HybridKnife® (HK) is a novel device used in endoscopic submucosal dissection (ESD) for mucosal lifting by high-pressure water flow in combination with the ERBEJET 2 system. It can reduce the procedure time by reducing the need for supplemental fluid injections using an injection needle. It has not been clinically introduced in Japan ; hence, we evaluated its efficacy and safety with ERBEJET 2 in this clinical trial under authorization by the ethics committee of the University of Tsukuba Hospital.</p><p>We performed ESD using the HK-ESD system for gastric mucosal tumors between April 2014 and June 2015. The procedure time, number of device changes, and perforation or bleeding rate were compared with those in patients who underwent conventional ESD using Dual Knife, IT knife2, or SAFE Knife V (C-ESD) as a reference. One operator (T.N.) with extensive experience in conventional ESD performed all the procedures. He had experience in performing experimental ESD with HK in several porcine models.</p><p>HK-ESD was performed in 23 patients (16 men and 7 women, aged 55-85 years) with gastric adenoma (n=6) or carcinoma (n=17), and C-ESD was performed in 22 patients (20 men and 2 women, aged 53-83 years) with gastric adenoma (n=2) or carcinoma (n=20). Patient characteristics did not significantly differ between the two groups. Dissection speed did not significantly differ between the HK-ESD and C-ESD groups [23±11 mm2/min (mean±SD) vs. 19±12 mm2/min, p=0.303]. The number of device changes was significantly lower in the HK-ESD group than in the C-ESD group [1.0±0.9 (mean±SD) vs. 9.2±6.5, p＜0.001]. In one case in the HK-ESD group, a tiny perforation occurred and was treated with endoclip closure. Postoperative bleeding did not occur in the HK-ESD group, but 3 cases in the C-ESD group were treated with endoclip due to postoperative bleeding.</p><p>HK reduced the procedure time of gastric ESD owing to fewer instrument changes without major complications. HK with ERBEJET 2 may be efficient and safe for gastric ESD.</p>

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