Khor Christopher J L, Ichimasa Katsuro, Tsao Stephen K K, Biber Ulrich, Saito Yutaka
Singapore General Hospital Singapore and Duke-NUS Medical School Singapore Singapore.
Showa University Northern Yokohama Hospital Yokohama Japan.
JGH Open. 2024 Nov 29;8(12):e70036. doi: 10.1002/jgh3.70036. eCollection 2024 Dec.
Endoscopic submucosal dissection (ESD) is considered the best modality for achieving en bloc resection of larger neoplastic mucosal lesions in the upper and lower gastrointestinal (GI) tract. Multiple devices are available for ESD, and refinements continue to be made to develop devices that improve the safety and efficiency of performing ESD. Submucosal injection with viscous fluids like glycerol, which prolong submucosal expansion, could facilitate the procedure. We aimed to evaluate the safety and performance of the new Erbe HYBRIDknife® flex, which combines electrosurgical dissection with waterjet-assisted injection in a slim and flexible form factor.
In a prospective animal study with six pigs, four endoscopists, each with 10-20 years of experience in ESD, performed 28 esophageal ESDs. One half was performed with physiological saline injectate, the other half with fructose-added glycerol. Various performance aspects were evaluated on a five-point scale [5 = best], including dissection properties, handling, and usability.
No perforations or major bleeding occurred. All resections were performed en bloc, with one technical failure (3.6%, 1 of 28). Performance scores were similar for saline and glycerol (4.5 ± 0.31 vs. 4.5 ± 0.32, = 0.36), as was dissection speed (13 ± 6.2 mm/min vs. 15 ± 6.1 mm/min, = 0.22).
We demonstrated that esophageal ESD can be performed safely and rapidly using HYBRIDknife flex, with excellent performance evaluation by the endoscopists. Combining this device with glycerol or saline is precise and effective for ESD, although experience could compensate for the theoretical disadvantage of using normal saline.
内镜黏膜下剥离术（ESD）被认为是实现上、下消化道（GI）较大肿瘤性黏膜病变整块切除的最佳方式。有多种设备可用于ESD，并且仍在不断改进以开发能提高ESD安全性和效率的设备。用甘油等粘性液体进行黏膜下注射可延长黏膜下扩张，有助于该手术。我们旨在评估新型爱尔博HYBRIDknife® flex的安全性和性能，该设备将电外科剥离与水刀辅助注射结合于纤细灵活的外形设计中。
在一项对六头猪进行的前瞻性动物研究中，四名具有10 - 20年ESD经验的内镜医师进行了28例食管ESD手术。其中一半手术使用生理盐水注射液，另一半使用添加果糖的甘油。从五个等级[5 = 最佳]评估了各个性能方面，包括剥离特性、操作和易用性。
未发生穿孔或大出血。所有切除均整块完成，有一次技术失败（28例中的1例，3.6%）。生理盐水和甘油的性能评分相似（4.5 ± 0.31对4.5 ± 0.32，P = 0.36），剥离速度也相似（13 ± 6.2毫米/分钟对15 ± 6.1毫米/分钟，P = 0.22）。
我们证明了使用HYBRIDknife flex可以安全、快速地进行食管ESD，内镜医师对其性能评价良好。将该设备与甘油或生理盐水结合用于ESD精确有效，不过经验可以弥补使用生理盐水的理论劣势。
