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. 1 A–H).
Fd 410lr
Manufactured by Olympus
Sourced in Japan, Germany
The FD-410LR is a laboratory equipment product from Olympus. It is designed for basic laboratory functions. The core function of the FD-410LR is to provide a solution for standard laboratory tasks.
Automatically generated - may contain errors
Lab products found in correlation
Gif q260j, by Olympus (14 mentions)
Kd 611l, by Olympus (13 mentions)
Kd 620lr, by Olympus (9 mentions)
Vio300d, by Erbe (8 mentions)
Kd 650l, by Olympus (6 mentions)
Kd 650q, by Olympus (4 mentions)
Apc300, by Erbe (4 mentions)
Dualknife kd 650l, by Olympus (4 mentions)
Gif 2tq260m, by Olympus (4 mentions)
Icc 200, by Erbe (4 mentions)
It knife, by Olympus (4 mentions)
Gif h260z, by Olympus (3 mentions)
Gif h260, by Olympus (3 mentions)
Kd 640l, by Olympus (3 mentions)
Hx 600 135, by Olympus (3 mentions)
D 201 11804, by Olympus (3 mentions)
Nm 4l 1, by Olympus (3 mentions)
Kd 610l, by Olympus (3 mentions)
Kd 650, by Olympus (3 mentions)
Eg29 i10, by Pentax (3 mentions)
46 protocols using fd 410lr
1
Endoscopic Submucosal Dissection for Gastric Neoplasia
2
Endoscopic Resection of Esophageal Lesions
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All tumors were evaluated by lugol chromoendoscopy or narrow-band imaging before ER, and SM invasion was assessed by endoscopic ultrasonography. The ER was performed using a single-channel endoscope (GIF-H260; Olympus Optical, Tokyo, Japan). After circumferential marking of the lesion, normal saline containing a mixture of epinephrine (0.01 mg/mL) and indigo carmine was injected into the SM layer and the lifted mucosa was circumferentially incised. Endoscopic SM dissection was performed using an insulated-tip knife 2 (IT knife; Olympus Optical) or IT knife (MTW Endoskopie, Wesel, Germany). Endoscopic mucosal resection was performed using a snare (SD-12U-1 or SD-9U-1; Olympus Optical) after circumferential incision. A UES-30 (Olympus Optical) or VIO 300D (Erbe Elektromedizin, Tübingen, Germany) system was used as the electrosurgical unit. Coagulation of all visible or bleeding vessels on the artificial ulcer was thoroughly performed using hemostatic forceps (FD-410LR; Olympus Optical).
3
Peroral Endoscopic Myotomy Procedure
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POEM procedures were performed by three experienced therapeutic endoscopists. Patients fasted for 24-48 h and were forbidden from drinking water for 4-6 h before the procedure. If gastroscopy or EUS revealed any liquid or food residue in the esophagus, a decompression tube was indwelled for at least 24 h before POEM, and nutrients were introduced intravenously. During the procedure, patients were placed in the left recumbent position under general anesthesia with tracheal intubation. The POEM procedure was performed as follows: (1) A submucosal injection (Boston Scientific, United States) of a mixture of saline and methylene blue was administered into the esophageal wall at 12-15 cm above the EGJ; (2) A submucosal tunnel passing over the EGJ was created using a hook knife (KD-620LR; Olympus Corp., Tokyo, Japan) or a triangle tipped knife (KD-640L; Olympus) extending 3 cm into the proximal stomach; (3) Inner circular myotomy began 2-3 cm below the tunnel entry and ended at the cardia; and (4) After careful hemostasis using hemostatic clips (FD-410LR; Olympus), several metal clips [ROOC-D-26-195; Micro-Tech (Nanjing) Co., Ltd., Jiangsu, China] were applied to close the mucosal entry. CO2 was used as the endoscope air supply. Prophylactic antibiotics and proton pump inhibitors were administered intravenously for at least 2 d after the procedure.
4
Endoscopic Submucosal Tunnel Dissection
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Before ESTD, all of the lesions were evaluated by endoscopy, enhanced ultrasound (EUS), and computed tomography (CT) of chest and abdomen. Prophylactic antibiotics were used in patients with large mucosal lesions (circumference ≥ 3/4) at half an hour before ESTD. ESTDs were performed by one endoscopist with an experience of more than 200 cases of ESD procedure. ESTD procedure included six steps, as shown in Figure 2 . When the lesion was detected by white light endoscopy, it was carefully observed under narrow band imaging (NBI) and iodine staining. Next, the margins were marked by a dual knife (KD-650Q, Olympus, Tokyo, Japan). A liquid mixture of 1:10000 adrenaline saline, sodium hyaluronate, glycerin fructose, and indigo carmine was used in submucosal injection. Both anal-side and oral-side incisions were made after submucosal injection, after which the submucosal tunnel was established from the oral side to the anal side and stopped at the anal-side incision. Thereafter, the remaining lateral margin incisions were made; thus, the lesion was completely resected. Finally, wound hemostasis was carefully performed by hemostatic forceps (FD-410LR, Olympus) or argon plasma coagulator (ERBE Corporation).
5
ESD Bleeding Management Protocol
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ESD was performed using a high-frequency generator (VIO 300D; Erbe Elektromedizin GmbH, Tubingen, Germany). Hemostatic forceps (FD-410LR; Olympus Co. or HDB2418W; Hoya Co., Tokyo, Japan) were used in soft coagulation mode at effect 6 and 70 W output. Prophylactic coagulation was performed on the visible vessels; however, ESD ulcer closure was not performed. Administration of an intravenous proton pump inhibitor (PPI) (lansoprazole, 30 mg, twice daily) was initiated on the day of the ESD and replaced with oral PPI (lansoprazole, 30 mg, once daily) the following day. After April 2015, vonoprazan (20 mg, once daily) was used as a substitute for PPI in patients receiving continuous antithrombotic agents. The patients were discharged 7 days after the ESD, and they underwent follow-up endoscopy 8 weeks after the procedure.
In our study, postoperative bleeding, regarded as a critical endpoint, was precisely defined as the occurrence of clinically evident bleeding necessitating immediate intervention, such as emergency endoscopic hemostasis and/or blood transfusion, coupled with a decrease in hemoglobin levels exceeding 2 g/dL.
In our study, postoperative bleeding, regarded as a critical endpoint, was precisely defined as the occurrence of clinically evident bleeding necessitating immediate intervention, such as emergency endoscopic hemostasis and/or blood transfusion, coupled with a decrease in hemoglobin levels exceeding 2 g/dL.
6
Endoscopic Procedures for Lesion Removal
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Endoscopic procedures followed at our institution have been previously described.18 (link) Briefly, for EMR, after we checked the lesion, saline solution containing epinephrine (0.01 mg/mL) mixed with indigo carmine was injected into the submucosal layer with a 23-gauge needle. The raised lesion was removed using an SD-9U-1 or SD-12U-1 snare (Olympus Co., Ltd., Tokyo, Japan) after circumferential mucosal incision. For ESD, the typical procedure involved marking, mucosal incision, and submucosal dissection with simultaneous hemostasis. After making several marking dots outside the lesion, saline solution containing epinephrine and indigo carmine was injected into the submucosal layer with a 23-gauge needle. A circumferential incision was made into the mucosa using a needle-knife (MTW Endoskopie Co., Ltd., Wesel, Germany) or insulated-tipped knife (Olympus Co., Ltd.). The submucosal layer was directly dissected with various knives until the lesion was completely removed. Hemostasis was achieved with hemoclips or hemostatic forceps (FD-410LR; Olympus Co., Ltd.) whenever bleeding or an exposed vessel was observed.
7
Submucosal Tunneling Endoscopic Resection
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A single channel endoscope (EPK-i7000; Pentax Optical Co. Ltd., Tokyo, Japan) attached with a transparent cap (MH-588; Olympus) was used during operation. A Dual knife (KD-650L; Olympus Optical Co. Ltd., Tokyo, Japan) was used for mucosal incision, submucosal tunneling and dissection of tumor (endocut mode 50w). A hot biopsy forceps (FD-410LR; Olympus) was used for hemostasis. In the final step, mucosal incision was closed by hemoclips (HX-610-135L Olympus). Other equipments included a high-frequency generator (300d; ERBE Elektromedizin GmbH, Tuebingen, Germany), and an argon plasma coagulation unit (APC300; ERBE Elektromedizin GmbH, Tuebingen, Germany). CO2 insufflation was used in all cases except for one patient who was comorbid with moderate chronic obstructive pulmonary disease (COPD).
8
Esophageal Submucosal Dissection in Anesthetized Mini Pigs
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The anesthetized mini pigs were placed in the left lateral position. All the procedures were performed using a gastroscope (EPK-I, Pentax, Tokyo, Japan) with a transparent cap. We marked the circumference of the lesion on both the cranial and caudal sides of the esophagus, at approximately 30 cm distance from the incisors. Following a submucosal injection of methylene blue and saline, submucosal dissection of 1-cm-length was performed on the local mucosa using a triangular knife (KD-640L, Olympus, Tokyo, Japan) (Figures 1A–F ). Hot coagulation forceps (FD-410LR, Olympus, Tokyo, Japan) were used for ensuring hemostasis.
9
Endoscopic Resection Techniques Protocol
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We selected these instruments to extend our previous study 4, 5 . The following instruments were used: Electronic gastroscope (Olympus GIF-Q260J, Olympus company, Japan), hyaline cap (D-201-11304, Olympus company, Japan), spiculiform cutting knife (KD-1 L-1, Olympus company, Japan), IT knife (KD-611 L, Olympus company, Japan), hook knife (KD-620 LR, Olympus company, Japan), injection needle (NM-200 L-0525, Olympus company, Japan), snare (AS-1-S, ASJ-1-S, COOK company, United States), hot biopsy forceps (FD-410 LR, Olympus company, Japan), hemostatic clip (HX-610-90, Olympus company, Japan; HX-600-135, Olympus company, Japan; Boston Resolution TM , Boston company, United States), high frequency electric knife (ERBE VIO 200S, ERBE company, Germany) and, Argon Plasma Coagulation instrument (ERBE APC2, ERBE company, Germany).
10
Instruments for POEM Procedure
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The instruments used for POEM procedure include Olympus -260 main engine, esophagogastroduodenoscopy (GIF-Q260J, Olympus), ERBE VIO300 system, OFP water insufflation, UCR CO2 insufflator, transparent cap (D-201-11804), injection needle (NM-4L-1, Olympus), IT2 knife (KD-611), dual knife (KD-650L), hook knife (KD-620LR), biopsy forceps (FD-410LR), clips (HX-610-135, Olympus), and other accessories.
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