Flush knife

Manufactured by Olympus

Sourced in Japan

The Olympus Flush Knife is a specialized medical device designed for endoscopic procedures. It features a retractable blade that can be used to perform precise incisions and dissections during various endoscopic operations. The core function of the Flush Knife is to provide a controlled cutting tool for minimally invasive surgical interventions.

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Lab products found in correlation

Coagrasper, by Olympus (2 mentions) Flush knife, by Fujifilm (2 mentions) Mucoup, by Johnson & Johnson (1 mentions) Ec 760zp 5 m, by Fujifilm (1 mentions) Interject, by Boston Scientific (1 mentions) Fd 410lr, by Olympus (1 mentions) Flex knife, by Olympus (1 mentions) Cf q260ai, by Olympus (1 mentions) Dualknife, by Olympus (1 mentions) It knife 2, by Olympus (1 mentions) Hook knife, by Olympus (1 mentions)

5 protocols using flush knife

Endoscopic Submucosal Dissection Protocol

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Initial submucosa injection was done with hyaluronic acid solution.(Sigmaviscs, Hyaltech Ltd, Livingston, United Kingdom and Mucoup, Johnson & Johnson KK, Tokyo, Japan). Flush knife non-tipped or ball-tipped (1.5mm or 2mm in length)(Fujinon Optical Co) with a high frequency automated electrosurgical generator (Erbotom ICC 200, ERBE VIO200S or VIO 300; ERBE Elektromedizin Ltd, Tübingen, Germany) in Endocut Effect 2 for mucosal incision or forced coagulation 35-45W were used for submucosal dissection. Soft coagulation (Effect 5-7, 80-100W) was used for coagulation of vessels with tip of Flush knife or hemostatic forceps (Coagrasper, Olympus Ltd, Japan) 15 (link) Our standard ancillary devices were Flush knife BT and distal attachment (Olympus Co) but in case of extensive severe fibrosis, these were changed to non-tipped Flush knife and short ST hood.
The standard technical approach to the lesions was conventional resection in which the incision was started from anal side with straight viewing and dissection was made towards to the oral side. The pocket creation method was sometimes applied for larger lesion with moderated fibrosis. Position changes was used to facilitate counter traction or to shift fluid pool during the procedures.

Suzuki N., Toyonaga T, & East J.E. (2017). Endoscopic submucosal dissection of colitis-related dysplasia. Endoscopy, 49(12).

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Novel Clip-with-Spring Device for ESD

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The internal traction device used in this study has been reported in our previous study (6 ). It is a novel clip-with-spring device consisting of a metal clip and a 5-mm long spring with 1 end fixed between the 2 claws and the other end shaped as a ring. It could be easily inserted through the working channel when claws of the clip are closed (Figure 1a). When the claws are unfolded, the spring could sway to either side of the claw plane to facilitate clip anchoring (Figure 1b). All ESDs were performed using a water-jet colonoscope (EC-760ZP-V/M; Fujifilm, Tokyo, Japan) with a transparent cap attached. Initial submucosal injection was performed by an injection needle (Interject; Boston Scientific, IN). Mucosal incision and submucosal dissection were performed by a Flush Knife (Fujifilm). Hemostasis was performed using the Flush Knife or hemostatic forceps (FD-410LR; Olympus, Tokyo, Japan). The mucosal defects were closed with metal clips (AGS MEDTECH, Hangzhou, China).

Li J., Wei Y., Zhang D., Hou X., Shen M., Chen K., Wu R., Peng K, & Liu F. (2022). Comparison Between Preincision Traction and On-Demand Traction in Assisting Colorectal Endoscopic Submucosal Dissection. Clinical and Translational Gastroenterology, 13(12), e00539.

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Endoscopic Submucosal Dissection Technique

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Endoscopic submucosal dissection was performed using a dual knife (Olympus), a flex knife (Olympus), and a flush knife (Olympus) through a standard, single-channel endoscope (Olympus CFQ260AI). The mixture solution was injected into the submucosal layer, and a circumferential mucosal incision was made using a flush knife or dual knife. Then, the submucosal layer was dissected using a flush knife, dual knife, or flex knife in the Endo-Cut mode (Effect 3, 60–80 W). Hemorrhage was controlled using hemostatic forceps, such as the Coagrasper (Olympus) in the soft coagulation mode (50 W). All procedures were performed by endoscopists who had each performed more than 100 colorectal ESD procedures. Finally, the resected specimen was retrieved with grasping forceps.

Hong J.Y., Kweon S.S., Lee J., Kim S.W., Seo G.S., Kim H.S, & Joo Y.E. (2018). Risk factors for procedure-related complications after endoscopic resection of colorectal laterally spreading tumors. Medicine, 97(41), e12589.

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Endoscopic Submucosal Dissection Technique

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The EGCs were first identified and demarcated using white-light endoscopy and chromoendoscopy with indigo carmine solution, after which marking around the lesions was performed by cautery with a needle knife. Glycerol (10% glycerol and 5% fructose; Chugai Pharmaceutical Co. Ltd., Tokyo, Japan) or MucoUp^® (Johnson and Johnson Co. Ltd., Tokyo, Japan) were then injected into the submucosal layer to lift the mucosa. A circumferential mucosal incision was made around the lesion using an insulation-tipped (IT) Knife 2 (Olympus Medical Systems Corp., Tokyo, Japan) or a Flush Knife (Fujifilm Corp., Tokyo, Japan). Submucosal dissection was performed using the IT Knife 2, a Hook Knife (Olympus Medical Systems Corp.) or the Flush Knife to achieve complete removal of the lesion. High-frequency generators (ICC 200 or VIO 300D; ERBE Elektromedizin GmbH, Tübingen, Germany) were used during marking, incision of the gastric mucosa and exfoliation of the gastric submucosa.

OHNITA K., ISOMOTO H., SHIKUWA S., YAJIMA H., MINAMI H., MATSUSHIMA K., AKAZAWA Y., YAMAGUCHI N., FUKUDA E., NISHIYAMA H., TAKESHIMA F, & NAKAO K. (2014). Early and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in a large patient series. Experimental and Therapeutic Medicine, 7(3), 594-598.

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Endoscopic Submucosal Dissection Procedure

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The ESD procedure involves marking the surrounding area of the lesion, submucosal injection of saline solution to lift the lesion, circumferential incision around the marking sites, and submucosal dissection. All ESD procedures were performed by a senior endoscopist with experience in over 100 gastric ESDs or by a junior endoscopist under the supervision and guidance of an experienced senior endoscopist. The main device used for ESD was the FLUSH knife (Olympus, Tokyo, Japan).

Tang Y.H., Ren L.L., Yu Y.N., Zhang S.H., Tian Z.B, & Mao T. (2023). Systemic immune-inflammation index in predicting non-curative resection of endoscopic submucosal dissection in patients with early gastric cancer. European Journal of Gastroenterology & Hepatology, 35(4), 376-383.

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