All procedures were performed using a standard colonoscope (EVIS PCF-Q260AI or GIF H260Z, Olympus Medical Systems Co., Tokyo, Japan) and carbon dioxide. The disposable distal attachment (D-201-13404; Olympus Medical Systems Co., Tokyo, Japan) was mounted onto the tip of the endoscope. A VIO 300D (ERBE Elektromedizin, Tübingen, Germany) or ICC200 (Erbe Elektromedizin Ltd., Tubingen, Germany) generator was used as the power source for the electrical cutting and coagulation. During the colorectal ESD procedure, a dual knife (Olympus Medical Systems Co., Tokyo, Japan) and insulated tipped (IT) knife (Olympus Medical Systems Co., Tokyo, Japan) were used. However, if the scope was positioned against the lesion or a rich vascular area, the dual knife was exchanged for a scissor-type grasping knife (Clutch cutter). A mixture of 1% hyaluronic acid (Mucoup; Johnson & Johnson K.K., Tokyo, Japan) and 10% glycerin (Glycerol; Chugai Pharmaceutical Co., Tokyo, Japan) was used as the injection liquid.
Mucoup
Manufactured by Johnson & Johnson
Sourced in Japan, United States
MucoUp is a laboratory equipment product designed to facilitate the collection and processing of mucosal samples. Its core function is to assist researchers and clinicians in the handling and preparation of mucosal tissue samples for various analytical and experimental purposes.
Automatically generated - may contain errors
Lab products found in correlation
Vio300d, by Erbe (10 mentions)
Dualknife, by Olympus (7 mentions)
Gif q260j, by Olympus (6 mentions)
Sb knife jr, by Sumitomo Bakelite (6 mentions)
Coagrasper, by Olympus (5 mentions)
It knife 2, by Olympus (4 mentions)
Icc 200, by Erbe (4 mentions)
Esg 100, by Olympus (4 mentions)
Pcf h290ti, by Olympus (4 mentions)
Itknife nano, by Olympus (4 mentions)
Gif h260z, by Olympus (3 mentions)
Kd 611l, by Olympus (3 mentions)
Cf h260azi, by Olympus (3 mentions)
Flex knife, by Olympus (3 mentions)
Pcf q260azi, by Olympus (3 mentions)
Dualknife j, by Olympus (3 mentions)
Dualknife kd 650l, by Olympus (2 mentions)
Coagrasper fd 411qr, by Olympus (2 mentions)
Flush knife, by Fujifilm (2 mentions)
Hook knife, by Olympus (2 mentions)
31 protocols using mucoup
1
Colonoscopic Endoscopic Submucosal Dissection
2
Endoscopic Submucosal Dissection Technique
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ESD was performed with a DualKnife (KD-650L; Olympus, Tokyo, Japan) or an IT Knife2 (KD-611L; Olympus). For the submucosal injection, a 1:1 solution of 0.4 % sodium hyaluronate (MucoUp; Johnson & Johnson K. K., Tokyo, Japan) and glycerol (Chugai Pharmaceutical Co. Ltd., Tokyo, Japan) was injected into the submucosa with a 25-gauge injection needle (Impact Flow; TOP Corp., Tokyo, Japan). Hemostatic forceps (FD410LR Coagrasper; Olympus) were used for the prophylactic coagulation of blood vessels and hemostasis for intraoperative bleeding. The VIO 300 D or ICC 200 (ERBE Elektromedizin, Tübingen, Germany) was used as a high-frequency generator.
3
Endoscopic Submucosal Dissection for Lesions
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ESD was performed using a prototype endoscope (GIF-Y0043; Olympus, Tokyo, Japan). We used a needle knife for precutting and performed circumferential mucosal incision and submucosal dissection with insulated-tip knife 2 and an electrosurgical generator (VIO 300D [ERBE, Tubingen, Germany] or ESG 100 [Olympus]). As the injection solution, we used a 1:1 mixture of 0.4% sodium hyaluronate (MucoUp®; Johnson & Johnson, New Brunswick, NJ, USA) and 10% glycerin solution plus a minute amount of indigo carmine [1 (link)-4 (link)]. We performed submucosal layer dissection using WLI and switched to DRI when exposed blood vessels were detected in the artificial ulcer or when unexpected bleeding occurred. We performed preventive coagulation for all detected vessels using hemostatic forceps, through soft coagulation (effect 4, 60 W) with an electrosurgical generator (VIO300D; ERBE) [5 (link)]. Video processors (EVIS LUCERA ELITTE system; Olympus) were used for recording the ESD procedure. The moment bleeding from blood vessels in the submucosal layer occurred during the dissection, we switched from WLI to DRI.
4
Gastric ESD Protocol with Dual Knife
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All study patients had undergone gastric ESD under deep sedation with propofol or general anesthesia. The procedures were performed using a single-channel endoscope (GIF-H260Z or GIF-Q260J; Olympus Medical, Tokyo, Japan) and an electrosurgical unit (VIO 300D; ERBE, Elektromedizin, Tübingen, Germany). Carbon dioxide was insufflated during the procedures.
The ESD protocol was as follows: 1) marking dots were placed circumferentially approximately 5 mm beyond the lesion, using a DualKnife (KD-441Q; Olympus Medical); 2) a mixture of 0.4% hyaluronate sodium solution (MucoUp; Johnson & Johnson K.K., Tokyo, Japan) and glycerol (Chugai Pharmaceutical, Tokyo, Japan) was injected into the submucosa; 3) the mucosa was then incised circumferentially and submucosal dissection performed using a DualJnife and an ITknife2, respectively (KD-611L; Olympus Medical). After en-bloc resection, visible vessels were coagulated using hemostatic forceps (Coagrasper; FD-411QR; Olympus Medical). Resection time was defined as the time from the start of submucosal injection to the resection of the lesion.
The ESD protocol was as follows: 1) marking dots were placed circumferentially approximately 5 mm beyond the lesion, using a DualKnife (KD-441Q; Olympus Medical); 2) a mixture of 0.4% hyaluronate sodium solution (MucoUp; Johnson & Johnson K.K., Tokyo, Japan) and glycerol (Chugai Pharmaceutical, Tokyo, Japan) was injected into the submucosa; 3) the mucosa was then incised circumferentially and submucosal dissection performed using a DualJnife and an ITknife2, respectively (KD-611L; Olympus Medical). After en-bloc resection, visible vessels were coagulated using hemostatic forceps (Coagrasper; FD-411QR; Olympus Medical). Resection time was defined as the time from the start of submucosal injection to the resection of the lesion.
5
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]).
6
Endoscopic Submucosal Dissection for Tumor Resection
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The ESD technique was previously described13 ). We used an endoscope (CF-Q260AI, or CF-H260AZI; Olympus, Tokyo, Japan) with a hood, a Flush Knife (Flush Knife; FujiFilm, Tokyo, Japan) and an electrosurgical unit (VIO200D; Erbe Elektromedizin, Tübingen, Germany). We injected 0.1% adrenaline and indigo-carmine locally in small doses, and 1% hyaluronic acid solution (MucoUp; Johnson & Johnson, Tokyo, Japan) was diluted 1.5 times with saline solution. The basic procedure for ESD was as follows. The diluted hyaluronic acid solution was injected into the submucosa distal to the tumor. Subsequently, an incision was made into the mucosa distal to the tumor. The submucosa was dissected just above the muscle layer toward the proximal side of the tumor. When an adequate amount of submucosal dissection was completed, the mucosal incision was extended proximally to make a circumferential mucosal incision. Finally, the remaining submucosal layer was dissected and the tumor was resected en bloc.
7
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.
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.
8
Endoscopic Submucosal Dissection Protocol
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ESD was performed as described.13 (link)–15 (link) Briefly, marks were made on the normal mucosa surrounding the lesion using a needle knife or argon plasma coagulation to indicate safety margins. The submucosal layer was injected with a solution of 10% glycerin, 0.9% NaCl, and 5% fructose (Glyceol; Chugai Pharmaceutical, Tokyo, Japan) or hyaluronic acid solution (MucoUp; Johnson and Johnson, Tokyo, Japan) to elevate the mucosa. Using an electrosurgical knife, such as an insulation-tipped knife (Olympus, Tokyo, Japan), hook knife (Olympus), flex knife (Olympus), flush knife (Fuji Film, Tokyo, Japan), or clutch cutter (Fuji Film), the normal mucosa surrounding the markings was circumferentially incised and the submucosa beneath the lesion was dissected, with additional injections of Glyceol or MucoUp as required, to remove the entire lesion. Hemostatic forceps (Coagrasper; Olympus) or a clutch cutter was used for hemostasis.
9
Endoscopic Resection Techniques for Polypoid Lesions
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ER was performed by EMR or ESD. EMR was performed with a two-channel videoendoscope (GIF-2T200, 2T-240 or 2TQ-260M, Olympus Medical Systems, Tokyo, Japan) for small (≤10 mm) polypoid lesions using the strip biopsy method [15 ]. ESD was performed using an insulation-tipped diathermic knife (IT knife, Olympus) [6 (link)] or IT knife-2 (Olympus) for large (>10 mm) polypoid or superficial lesions. Physiologic saline was used as the injection solution for EMR, and 10% glycerin solution (Glyceol, Chugai Pharmaceuticals, Tokyo, Japan) or 0.4% sodium hyaluronate (MucoUp, Johnson & Johnson K.K., Tokyo, Japan) for ESD. Intelligent Cut and Coagulation 200 or VIO300D (ERBE, Tubingen, Germany) electrosurgical units were used to generate high-frequency electric currents.
10
Endoscopic Submucosal Dissection Technique
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ESD was performed with a conventional endoscope (GIF-H290Z, Olympus, Tokyo, Japan). We used magnifying endoscopy with narrow band imaging (NBI) together with white light endoscopy to identify the demarcation line of lesions. After recognizing the demarcation line, marking dots were placed around the lesion by coagulation using a needle knife. Submucosal injections were performed to lift the mucosal layer using glycerol (10% glycerol and 5% fructose; Chugai Pharmaceutical Co., Tokyo, Japan) or MucoUp (0.4% sodium hyaluronate; Johnson & Johnson, New Brunswick, New Jersey, USA) with a small amount of indigo carmine as injection solutions. Circumferential mucosal incisions and submucosal dissections were performed using an IT Knife 2 and an electrosurgical generator (VIO 300D; Erbe, Tubingen, Germany). The electrosurgical unit was set at a cutting current for mucosal incisions on Drycut mode, effect 4, 40W, and at a coagulating current for submucosal dissections on Soft Coagulation mode, effect 3, 30W.
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