ESD was performed with patients under conscious sedation using midazolam, pethidine, or propofol using an EVIS LUCERA SPECTRUM system (Olympus, Tokyo, Japan), with a GIF-H260, or a GIF-H260Z high-resolution upper gastrointestinal endoscope (Olympus). We also performed magnifying endoscopy with narrow-band imaging and acetic acid-indigo carmine chromoendoscopy to determine the lateral extent of the gastric tumor before ESD. Circumferential markings were created approximately 3 mm outside the border of the lesion by using APC. We injected a 0.025 mg/mL epinephrine solution into the submucosal layer. Circumferential cutting was performed with a standard needle-knife or insulation-tipped diathermic knife (KD-610L; Olympus) or flex knife (KD-630L; Olympus) outside the indicated area. After completing circumferential cutting, the lesion was dissected using an insulation-tipped diathermic knife or flex knife. During ESD, bleeding was coagulated using APC or hemostatic clips. After completion of ESD, we coagulated all non-bleeding visible vessels in the artificial ulcer bed.
Kd 630l
Manufactured by Olympus
Sourced in Japan
The KD-630L is a precision laboratory centrifuge designed for a variety of applications. It features a brushless DC motor, electronic speed control, and a digital display for monitoring speed and time.
Automatically generated - may contain errors
Lab products found in correlation
Kd 610l, by Olympus (2 mentions)
Icc 200, by Erbe (2 mentions)
Evis lucera spectrum system, by Olympus (1 mentions)
Gif h260, by Olympus (1 mentions)
Flex knife, by Olympus (1 mentions)
Cf 240i, by Olympus (1 mentions)
Kd 10q 1, by Olympus (1 mentions)
Flush knife, by Fujifilm (1 mentions)
Kd 620lr, by Olympus (1 mentions)
D 201 11804, by Olympus (1 mentions)
Pcf h290ti, by Olympus (1 mentions)
Vio 3, by Erbe (1 mentions)
Gif q260j, by Olympus (1 mentions)
Mucoup, by Johnson & Johnson (1 mentions)
Pcf q260ji, by Olympus (1 mentions)
Kd 620l, by Olympus (1 mentions)
Vio300d, by Erbe (1 mentions)
4 protocols using kd 630l
1
Endoscopic Submucosal Dissection of Gastric Tumors
2
Endoscopic Resection of Early Gastric Cancer
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The FlexKnife (KD-630L; Olympus, Tokyo, Japan) and the FlushKnife (DK-2618JN; Fujifilm, Tokyo, Japan) were used from May 2002 to June 2005 and after June 2005, respectively. A conventional needle knife (KD-10Q-1, Olympus), a hook knife (KD-620LR, Olympus), and the ST hood (DH-16CR, Fujinon) were used as ancillary devices. A single-channel endoscope (CF 240I, Olympus) was used with a 4-mm-long transparent hood to maintain a clear operating field. An electrosurgical generator, ICC 200, VIO 300 D (Erbe Elektromedizin, Tübingen, Germany), was also used.
The resected specimens were collected intact, stretched and pinned, fixed in formalin, sliced into 2-mm sections, and assessed microscopically. Histopathologic diagnosis was based on the Vienna classification. An sm1 cancer was defined as a minute submucosal cancer (< 1000 μm), and an sm2 cancer was defined as a submucosal deep cancer (≥ 1000 μm). After thorough pathologic assessment, if the lesion was resected en bloc, the treatment was considered an en bloc resection, and if the lesion was resected en bloc with margins negative for neoplasm, it was considered an en bloc R0 resection.
The resected specimens were collected intact, stretched and pinned, fixed in formalin, sliced into 2-mm sections, and assessed microscopically. Histopathologic diagnosis was based on the Vienna classification. An sm1 cancer was defined as a minute submucosal cancer (< 1000 μm), and an sm2 cancer was defined as a submucosal deep cancer (≥ 1000 μm). After thorough pathologic assessment, if the lesion was resected en bloc, the treatment was considered an en bloc resection, and if the lesion was resected en bloc with margins negative for neoplasm, it was considered an en bloc R0 resection.
3
Endoscopic Submucosal Dissection Protocol
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ESD was performed by seven endoscopists specialized in endoscopic colorectal treatment (procedure and devices of ESD described in previous reports).26 , 27 , 28 The following endoscopes were used: a water‐jet system (GIF‐Q260J; Olympus, Tokyo, Japan [September 2003–September 2008]) gastroscope and two water‐jet systems (PCF‐Q260JI; Olympus [October 2008–February 2018] and PCF‐H290TI; Olympus [from March 2018]) colonoscopes. A triangle‐tip knife (KD‐630L; Olympus [September 2003–September 2008]) and a flush knife (DK2618LN; Fujifilm Medical, Tokyo, Japan [from October 2008]) were used as endo‐knives. A transparent hood (D‐201‐11804; Olympus) was attached to the tip of the endoscope to enhance field visualization and ensure stable dissection. From September 2003 to March 2008, the injected agent was a 1% hyaluronic acid solution (Suvenyl; Chugai Pharmaceutical, Tokyo, Japan) mixed with a 10% glycerin, 5% fructose, and 0.9% saline solution (Glyceol; Chugai Pharmaceutical). From April 2008, a 0.4% hyaluronic acid solution (Mucoup; Johnson & Johnson K.K., Tokyo, Japan) was used.29 , 30 The electrosurgical units used were the ICC 200 (Erbe Elektromedizin, Tübingen, Germany [September 2003–August 2018]) and the VIO3 (Erbe Elektromedizin, Tübingen, Germany [from September 2018]).
4
Endoscopic Submucosal Dissection Technique
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Two experienced endoscopists (M.S.L. and S.J.H) performed all of the procedures. All patients underwent procedures under sedation with intravenous administration of midazolam and propofol. The electrosurgical unit used was the VIO300D or ICC 200 (ERBE, Tuebingen, Germany). The circumferential margin was marked with argon plasma coagulation or a hook knife (KD-620L, Olympus, Tokyo, Japan). A mixture of indigo carmine and diluted epinephrine (1:100,000) in normal saline solution was used for submucosal injection. After submucosal injection, the mucosal layer around the lesion was incised with various knives such as a hook knife, insulated-tip knife (KD-610L, 611L Olympus, Tokyo, Japan), or flex knife (KD-630L, Olympus, Tokyo, Japan), and the submucosal layer was dissected. Hemostatic forceps (Coagrasper, FD-410LR, Olympus, Tokyo, Japan) were used to control bleeding during ESD and at any visible vessel in the post-ESD ulcer site.
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