ESD was performed using a therapeutic endoscope with a waterjet function (GIF-Q260 J, GIF-H290 T, GIF-2TQM, PCF-Q260JI, or PCF-H290TI; Olympus Medical Systems, Tokyo, Japan) and carbon dioxide insufflation. A transparent hood (D-201-11804, D-201-13404; Olympus Medical Systems, Tokyo, Japan), short-type small-caliber tip transparent hood, or small-caliber tip transparent hood (DH-28GR, DH-33GR; Fujifilm, Tokyo, Japan) were used. We performed a mucosal incision or submucosal dissection using a 1.5-mm DualKnife J (Olympus Medical Systems, Tokyo, Japan). Minor bleeding was controlled by placing the deviceʼs tip into the outer sheath, but hemostatic forceps (Coagrasper, Olympus Medical Systems, Tokyo, Japan) were also used. A submucosal injection of 10 % glycerin solution (Glyceol; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan) containing a small amount of indigo carmine and epinephrine (1:400,000 dilution) was given. In complex cases, 0.4 % sodium hyaluronate (Mucoup, Boston Scientific Japan, Tokyo, Japan) was used. We used the VIO 300 D (ERBE Elektromedizin, Tübingen, Germany) with a dry cut (effect 2.2) for mucosal incisions, swift coagulation (effect 3.5) for submucosal dissection, spray coagulation (effect 1.2) for hemostasis using the tip of the knife, and soft coagulation (effect 6.0) for hemostasis using the Coagrasper.
Dh 28gr
Manufactured by Fujifilm
Sourced in Japan
The DH-28GR is a lab equipment product from Fujifilm. It is a device designed for specific laboratory functions. No further details can be provided while maintaining an unbiased and factual approach.
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Lab products found in correlation
Vio300d, by Erbe (4 mentions)
Gif q260j, by Olympus (3 mentions)
1.5 mm dualknife j, by Olympus (2 mentions)
Gif h290t, by Olympus (2 mentions)
Pcf q260ji, by Olympus (1 mentions)
Pcf h290ti, by Olympus (1 mentions)
D 201 11804, by Olympus (1 mentions)
D 201 13404, by Olympus (1 mentions)
Dh 33gr, by Fujifilm (1 mentions)
Coagrasper, by Olympus (1 mentions)
Gif q240, by Olympus (1 mentions)
Ed 410lr, by Olympus (1 mentions)
Kd 620lr, by Olympus (1 mentions)
Gif h260, by Olympus (1 mentions)
Kd 640l, by Olympus (1 mentions)
Pcf q260azi, by Olympus (1 mentions)
Pcf q240zi, by Olympus (1 mentions)
Cf h260azi, by Olympus (1 mentions)
Cf fh260azi, by Olympus (1 mentions)
Cf hq290azi, by Olympus (1 mentions)
10 protocols using dh 28gr
1
Endoscopic Submucosal Dissection Procedure
2
Endoscopic Submucosal Dissection for Gastric Tumor
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ESD was performed by experts with more than 6 years of experience in ESD. Patients were sedated with intravenous propofol or midazolam, and blood pressure, electrocardiography, oxygen saturation, and bispectral index readings were monitored throughout the procedure. All ESD procedures were performed using an upper gastrointestinal endoscope (GIF-Q240 or GIF-Q260J; Olympus Medical Systems, Tokyo, Japan), a standard electrosurgical generator (VIO300D or ICC200; ERBE, Tübingen, Germany), and a hook knife (KD-620LR; Olympus Medical Systems). Carbon dioxide insufflation was performed during the procedure. Mucosal markings around the tumor margins were created with the hook knife. Glycerol (10% glycerin and 5% fructose) was injected into the submucosa (SM) to elevate the lesion, and bleeding vessels were coagulated using monopolar Coagrasper hemostatic forceps (ED-410LR; Olympus Medical Systems). Figure 1 depicts a representative case of GTC on the suture line. In cases of severe fibrosis along the suture line, an ST hood short-type (DH-28GR; Fujifilm, Tokyo, Japan) and clip-with-line method was used to provide effective countertraction and good visualization [12 (link)]. The lesion was removed as a curative resection with tumor-free horizontal and vertical margins, and the histological type was well-to-moderately differentiated mucosal tubular adenocarcinoma.
3
Endoscopic Submucosal Dissection Procedure
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A forward-viewing endoscope with an outer diameter of 9.8 mm (GIF-H260, Olympus Medical Systems, Japan), which is routinely employed for upper gastrointestinal (GI) examinations, was used with a short ST hood (DH-28GR, Fujifilm, Japan). A triangle-tip knife (KD-640L, Olympus) was used to create the submucosal tunnel as well as to divide circular muscle bundles. Coagulating forceps (FD-411QR Coagrasper, Olympus) were used to close larger vessels prior to dissection and for hemostasis. Carbon dioxide gas was used for insufflation during the procedure with a CO2 insufflator (UCR, Olympus). For electrosurgery, the VIO 300D electrogenerator (ERBE, Tübingen, Germany) was used. Finally, hemostatic clips (HX-610-90L EZ Clip and HX-610-90S EZ Clip Olympus) were applied for closure of the mucosal entry site.
4
Colonoscopic Assessment and ESD for Colonic Diverticula
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All diagnostic colonoscopies were performed using magnifying colonoscopes (CF-HQ290AZI, CF-H260AZI, CF-FH260AZI, PCF-Q260AZI or PCF-Q240ZI, Olympus, Tokyo, Japan).
After white-light observation, narrow-band imaging (NBI) with magnification and chromoendoscopy was performed to determine the pit pattern of the tumor
15 (link)
to assess whether it was suitable for ESD. If a diverticulum was detected, careful examination was performed to determine the size of the diverticulum and the pit pattern of the tumor involving the diverticulum. A short-type ST hood (DH-28GR Fujifilm Medical Co., Tokyo, Japan) was used to measure the size of diverticulum. Biopsy was not performed before ESD because that could cause fibrosis, which might interfere with submucosal lifting.
After white-light observation, narrow-band imaging (NBI) with magnification and chromoendoscopy was performed to determine the pit pattern of the tumor
15 (link)
to assess whether it was suitable for ESD. If a diverticulum was detected, careful examination was performed to determine the size of the diverticulum and the pit pattern of the tumor involving the diverticulum. A short-type ST hood (DH-28GR Fujifilm Medical Co., Tokyo, Japan) was used to measure the size of diverticulum. Biopsy was not performed before ESD because that could cause fibrosis, which might interfere with submucosal lifting.
5
ESD Technique for Gastric Neoplasia
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Gastroscope water jet irrigation was used as the ESD scope (GIF Q260J, Olympus, Tokyo, Japan). The scope is short, which allows faster instrument exchange, and has a small diameter, which allows easy entry into the submucosal space. A transparent distal hood was applied to the distal end of the ESD scope (D-201-11304, Olympus; or DH-28GR, Fujifilm, Tokyo, Japan). To cut the mucosa and dissect the submucosal layer, a 20-W pulse-cut-slow setting or a 20-W force coagulation 2 setting of the electrocoagulation unit (ESG 100, Olympus) was used. The coagulation mode was 80-W soft coagulation or 20-W force coagulation 2. We used only an Olympus Dual J knife. Voluven (6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride injection) with minimal or no indigo carmine was used as the submucosal injection fluid.
All lesions were evaluated with magnified narrow band imaging (NBI) according to the Japan NBI Expert Team classification to evaluate the invasion depth before ESD. We did not perform chromoendoscopy with crystal violet to evaluate the Kudo classification for all the lesions. We performed magnified chromoendoscopy in some lesions only when magnified NBI failed to distinguish invasion depth of the lesion.
All lesions were evaluated with magnified narrow band imaging (NBI) according to the Japan NBI Expert Team classification to evaluate the invasion depth before ESD. We did not perform chromoendoscopy with crystal violet to evaluate the Kudo classification for all the lesions. We performed magnified chromoendoscopy in some lesions only when magnified NBI failed to distinguish invasion depth of the lesion.
6
Endoscopic Submucosal Dissection Technique
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An endoscope with a waterjet instrument (EC-580RD/M; Fujifilm, Tokyo, Japan), carbon dioxide insufflation, and a small-caliber tip transparent (ST) hood (DH-15GR or DH-28GR; Fujifilm) fitted to the tip of the endoscope were used. When adequate maneuverability could not be maintained using a standard colonoscope, we used a balloon-assisted endoscope (EC-450BI5 and TS-13101; Fujifilm). For submucosal injection, 0.4 % sodium hyaluronate solution (MucoUp; Seikagaku, Tokyo, Japan) with 0.002 % – 0.004 % indigo carmine and 0.001 % epinephrine was used. The mucosal incision and submucosal dissection were performed by using a Flush knife BT (DK2618JB-15; Fujifilm) or a DualKnife (KD-650Q; Olympus, Tokyo, Japan). Hot hemostatic forceps (HOYA Corporation, Tokyo, Japan) were used to control bleeding. A VIO300 D (ERBE Elektromedizin GmbH, Tübingen, Germany) electrosurgical generator was used. The mucosal incision was made with Endo-Cut I (effect, 1; duration, 4; interval, 1). Submucosal dissection was done using swift coagulation (effect 4, 25 W). Hemostasis was done with soft coagulation (effect 4, 80 W) 14 (link).
7
Endoscopic Submucosal Dissection Technique
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ESD was performed using a therapeutic endoscope with water-jet function (GIF-H290T; Olympus Medical Systems, Tokyo, Japan). A short-type small-caliber transparent hood (DH-28GR; Fujifilm, Tokyo, Japan) was attached to the tip of the endoscope. We used a 1.5-mm DualKnife J (Olympus Medical Systems, Tokyo, Japan) and submucosal injection of 10% glycerin solution (Glycerol; Chugai Pharmaceutical Co., Ltd., Tokyo, Japan). We used VIO 300D (ERBE Elektromedizin, Tübingen, Germany) with Endocut I (effect 2, cut interval 2, cut duration 2) for mucosal incision and swift coagulation (effect 3, 30 W) for submucosal dissection.
8
Endoscopic Therapeutic Procedures
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Therapeutic channel (3.7 mm) endoscope (GIF-1TH190; Olympus, Tokyo, Japan), tapered transparent cap (DH-28GR; Fujifilm, Tokyo, Japan), bipolar device (Speedboat-RS2; Creo Medical Ltd, Chepstow, Wales, UK), endoscopic clips (EZ Clip, HX-610 – 090L; Olympus Corp.), and coagulation forceps (Coagrasper G, FD-412LR, Olympus, Japan) were used.
9
Esophageal Endoscopy Under Anesthesia
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All patients underwent endoscopy under anesthesia (midazolam/pethidine hydrochloride) without the use of anticholinergic drugs. A GIF-H260 scope was used with an ST Hood short-type (DH-28GR; Fujifilm, Japan) attached in the first esophageal observation [14 ]. After the endoscope was removed, observations were performed again without the ST Hood short-type.
10
Peroral Endoscopic Myotomy Procedure
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A forward-viewing endoscope with a 3.2 mm instrumentation channel (GIF-H260J; Olympus Medical Systems) and a short ST hood (DH-28GR; Fujifilm) were used. POEM was performed under general anesthesia with endotracheal intubation and carbon dioxide insufflation. First, approximately 5 mL of saline mixed with 0.3 % indigo carmine was injected into the submucosa (
Fig. 2a ), and a longitudinal mucosal incision was made in the mucosal surface to gain access to the submucosal space. This same saline mixture was used for subsequent injections via the FlushKnife BT. Second, a submucosal tunnel was created and extended past the esophagogastric junction (EGJ) for 2 – 3 cm into the gastric cardia (
Fig. 2b,c ). The submucosal tunnel was usually created in the 5 o’clock position, or the 7 o’clock position for patients with a history of prior Heller myotomy in order to avoid fibrosis from the previous surgery. Complete gastric myotomy was confirmed by using a second, small-caliber endoscope
20 (link)
. Third, a proximal-to-distal circular myotomy was performed, with care, to preserve the longitudinal muscle layers of the esophagus and stomach (
Fig. 2 d,e ). The myotomy was extended 2 – 3 cm into the gastric cardia beyond the EGJ in patients with achalasia and in those with other spastic esophageal motility disorders. Finally, the mucosal entry was closed using endoscopic clips (
Fig. 2f ).
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A forward-viewing endoscope with a 3.2 mm instrumentation channel (GIF-H260J; Olympus Medical Systems) and a short ST hood (DH-28GR; Fujifilm) were used. POEM was performed under general anesthesia with endotracheal intubation and carbon dioxide insufflation. First, approximately 5 mL of saline mixed with 0.3 % indigo carmine was injected into the submucosa (
20 (link)
. Third, a proximal-to-distal circular myotomy was performed, with care, to preserve the longitudinal muscle layers of the esophagus and stomach (
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