Gif q260j

ESD was performed by four endoscopists (S.T., S.O., Y.N., and H.T.). We predominantly used a DualKnife J (Olympus Medical Systems Co., Ltd, Tokyo, Japan), IT knife nano (Olympus Medical Systems Co., Ltd, Tokyo, Japan), or Flex knife (Olympus Medical Systems Co. Ltd, Tokyo, Japan). Depending on the situation, we also used an SB knife Jr. (Sumitomo Bakelite Co., Ltd, Tokyo, Japan). Carbon dioxide (CO₂) insufflation was used instead of room air insufflation. ESD procedures were performed with a high-resolution magnifying video endoscope (CF-H260AZI, CF-Q260JI, or PCF-H290TI; Olympus Optical Co., Ltd, Tokyo, Japan) or upper gastrointestinal endoscope (GIF- Q260J; Olympus Optical Co. Ltd, Tokyo, Japan). Undiluted 0.4% sodium hyaluronate (MucoUp^®; Johnson & Johnson K.K., Tokyo, Japan) was used as the injection solution. After injection of the solution into the submucosal layer, a circumferential incision was made using a single ESD knife. The submucosal layer was then dissected using one or two ESD knives. Visible vessels or arteries in the ulcers were grasped precisely with hemostatic forceps.

All ESD procedures were performed for hospitalized patients. A total of 5–10 mg of midazolam hydrochloride and 15 mg of pentazocine hydrochloride were administered intravenously for sedation just before and during the procedure. A standard single-channel endoscope (GIF-Q260J; Olympus Optical, Tokyo, Japan) was used. VIO 300D or ICC 200 (ERBE Elektromedizin, Tubingen, Germany) was used as the power source for electrical cutting and coagulation. We performed ESD using a standard technique described elsewhere [24 (link)–26 (link)]. Briefly, marking dots were placed around the lesion using an endo-knife. To lift the lesion, a normal saline solution and hyaluronate sodium with a small amount of epinephrine (0.001 mg/mL) and 0.8% indigo carmine were injected in the submucosal layer. Then, a circumferential mucosal incision was created and submucosal dissection was performed with an endo-knife to complete the removal of the lesion. Hemostasis was achieved for bleeding or exposed vessels by using an endo-knife or hemostatic forceps. Insulated tip knife, needle-type knife, or scissor-type knife was mainly used as an endo-knife for ESD. Hook knife (KD-620; Olympus) was sometimes used during the dissection of the submucosa as a rescue device, which was useful for dissecting the fibrotic site.

All ESD procedures were performed with a standard single-channel endoscope (GIF-Q260J or GIF-H260Z, Olympus Optical Co. Ltd., Tokyo, Japan). The typical procedure sequence consisted of marking, mucosal incision, and then submucosal dissection with simultaneous hemostasis. The details of each step are described below.
Firstly, lesion was examined via chromoendoscopy using indigo carmine dye spraying. After making several marking dots circumferentially around the lesion with a needle knife (KD-10Q-1-A, Olympus Optical Co. Ltd., Tokyo, Japan) or a needle knife papillotome (MTW Endoscopy, Wesel, Germany), a saline solution containing epinephrine (0.01 mg/mL) mixed with indigo carmine was injected into the submucosal layer by using a 21-gauge needle in order to lift the lesion away from the muscle layer. A circumferential incision was made in the mucosa by using a needle knife and an insulated-tip knife (KD-610L, Olympus Optical Co. Ltd., Tokyo, Japan). The submucosal layer was dissected directly with various knives until complete removal was achieved. Endoscopic hemostasis was performed with hemoclips or hemostatic forceps whenever bleeding or exposed vessels were observed.

In this study, an upper GI endoscope (GIF-Q260J; Olympus Optical Co., Tokyo, Japan) with a transparent attachment cap (D201-10704, 4 mm; Olympus Optical Co.) was used for all the procedures. A dual knife (KD-650L; Olympus Optical Co.) was used for the circumferential mucosal resection, and the submucosal dissection was mainly performed using an IT knife nano (KD-612L; Olympus Optical Co.). A VIO generator (VIO300D; Erbe Elektromedizin, Tubingen, Germany) was used for all the ESD procedures as a high-frequency generator unit. The settings were as follows: Endocut I Effect 3 (duration 2, interval 2), 60 W for all ESD procedures, and Swift Coagulation, 45 W for submucosal dissection. Submucosal injection was performed using Glyceol mixed with indigo carmine using a 23-gauge, 4 mm long needle (Olympus, Optical Co).

ESD was done with a single channel endoscope with jet function available (GIF Q260J, Olympus Optical Co. Ltd., Tokyo, Japan). Chromoendoscopy (using indigo carmine) and magnification endoscopy with narrow-band imaging (ME-NBI, GIF H260Z, Olympus Optical Co. Ltd., Tokyo, Japan) were used to define the carcinomatous area. A dual knife (KD-611L, Olympus Optical Co. Ltd., Tokyo, Japan) was used to mark the lesion. Saline mixed with epinephrine (0.01 mg/mL) and 0.5% indigo carmine was injected into the submucosa to lift the lesion. A circumferential mucosal incision was made around the lesion using a dual knife and/or IT knife 2 (KD-650L, Olympus Optical Co. Ltd., Tokyo, Japan). Lesions were completely removed by submucosal dissection using an IT knife 2 and/or a dual knife. Endoscopic hemostasis was performed either with hemostatic forceps (FD-410LR, Olympus Optical Co. Ltd., Tokyo, Japan) or the knife itself for bleeding or an exposed vessel. All visible vessels on the artificial ulcer were coagulated using hemostatic forceps, irrespective of the presence or absence of bleeding. For synchronous multiple lesions, marking was performed for all lesions initially. Resections subsequently were performed in the same way (Fig. 1A–H).