Sb knife jr

We performed ESD using a high-resolution video endoscope (CF-H260AZI, PCF-Q260AZI, CF-Q260JI, PCF-H290TI, Olympus, Tokyo, Japan) equipped with a transparent tip hood (ST Hood short type, Fujifilm, Tokyo, Japan), which allowed good visualization and stable dissection. DualKife J (Olympus) was mainly used for incision and submucosal dissection, with an electrosurgical generator (ESG-100, Olympus). When respiratory fluctuation was strong or scope operability was poor, we used ITknife nano (Olympus), whose tip insulator reduced risk of perforation, or SB knife Jr (Sumitomo Bakelite, Tokyo, Japan), which allows safe dissection simply by opening and closing the scissors without moving the knife itself. The pulse-cut slow-mode setting (25 W) was used for mucosal incisions, and the forced coagulation mode (25 W) was used for submucosal dissection with DualKnife J and ITknife nano. We used the pulse-cut fast-mode setting (30 W) and soft coagulation (40 W) mode with the SB knife Jr. We mixed equal volumes of 0.4 % sodium hyaluronate (Muco Up, Johnson & Johnson, New Brunswick, NJ, USA) and 10 % glycerin solution, and added a small amount of indigo carmine (0.2 mL per 20 mL sodium hyaluronate + glycerin). For endoscopic hemostasis, we used hemostatic forceps (Coagrasper, Olympus). The ESD procedure was performed by seven endoscopists with various skill levels.

ESDs were performed by two endoscopic experts (SO and ST) in all cases. A standard tip hood (Olympus), ST hood (FUJIFILM, Japan) or its short-type (FUJIFILM) was attached to the tip of the endoscope as appropriate in each case. A 50/50 mixture of 0.4 % sodium hyaluronate (Muco Up; Boston Scientific, Japan) and 10 % glycerin solution was added to a small amount of indigo carmine, which was initially injected into the submucosa. Next, a circumferential incision was made, and submucosal dissection was performed. The Dual Knife (Olympus) or Dual Knife J (Olympus) were used as cutting devices at the onset of the procedure. In specific situations, such as with cases of severe submucosal fibrosis, other knives, including the ITknife nano (Olympus) or SB Knife Jr (Sumitomo Bakelite, Japan) were additionally used.
All specimens were fixed in 10 % formalin buffer, sliced into 2-mm widths, and examined under a microscope. Histological complete resection was defined as pathologically identified en bloc resection with negative horizontal and vertical margins.