AIM to compare the efficacy and safety of a hook knife(HO) with a hybrid knife(HK) during endoscopic submucosal tunnel dissection(EStD) procedure.METHODS Between August 2012 and December 2015, the ESt D procedure was ...AIM to compare the efficacy and safety of a hook knife(HO) with a hybrid knife(HK) during endoscopic submucosal tunnel dissection(EStD) procedure.METHODS Between August 2012 and December 2015, the ESt D procedure was performed for 83 upper GI submucosal lesions, which originated from the muscularis propria layer identified by upper endoscopy and endoscopic ultrasonography. Of these, 34 lesions were treated by a HO, whereas 49 lesions were treated by a HK. Data regarding age, gender, presenting symptoms, tumor location and size, procedure time, complications, en bloc resection rate and others were analyzed and compared between the two groups.RESULTS there were no significant differences in the age, gender, presenting symptoms and tumor location between the two groups. EStD was successfully completed in all the patients, and no case was converted to laparoscopy. the mean procedure time was significantly shorter in the HK group than in the HO group(41.3 ± 20.3 min vs 57.2 ± 28.0 min, p = 0.004). the mean frequency of device exchange was 1.4 ± 0.6 in the HK group and significantly less than 3.3 ± 0.6 in the HO group(p < 0.001). the differences in tumor size and histopathological diagnoses were not significant between the two groups(p = 0.813, p = 0.363, respectively). Both groups had an equal en bloc resection rate and complete resection rate. Additionally, the complication rate was similar between the two groups(p = 0.901). During the follow-up, no recurrence occurred in either group.CONCLUSION We demonstrate for the first time that HO and HK do not differ in efficacy or safety, but HK reduces the frequency of device exchange and procedure time.展开更多
Buried bumper syndrome(BBS) is an uncommon but serious complication of percutaneous endoscopic gastrostomy. It involves the internal fixation device, or "bumper", migrating into the gastric wall and subseque...Buried bumper syndrome(BBS) is an uncommon but serious complication of percutaneous endoscopic gastrostomy. It involves the internal fixation device, or "bumper", migrating into the gastric wall and subsequent mucosal overgrowth. We described a case series of four patients with BBS treated with a novel endoscopic technique using a Hook Knife between June 2016 and February 2017. The Hook Knife is a rotating L-shaped cutting wire designed for hooking tissue and pulling it away from the gastric wall towards the lumen. The technique was successful in all four cases with no complications. Each patient was discharged on the day of treatment. The Hook Knife is a manoeuvrable, safe and effective device for endoscopic removal of buried bumpers and could avoid surgery in a high risk group of patients. To our knowledge this technique has not been described previously. We suggest that this technique should be added to the treatment algorithms for managing BBS.展开更多
AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affilia...AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affiliated to The Catholic University of Korea.ESD was performed in 76 consecutive patients with gastric epithelial neoplasia by using the GTS(37 patients)or the hook knife plus coagrasper(HKC)(39 patients).The complete resection rate,complication rate,total time elapsed and elapsed time per square centimeter of the dissected specimen were analyzed between the GTS and HKC group.RESULTS:The mean age of the GTS group was 62.3±11.4 years and mean age of the HKC group was 65.6±10.1 years.Differentiated adenocarcinoma was found in32.4%in the GTS group and 33.3%in the HKC group.The procedures were performed without interruption in every case in both groups.The en bloc resection rates of both groups were 100%.The total time elapsed during the procedure was 44.54±21.72 min in the GTS group and 43.77±21.84 min in the HKC group(P=0.88)and the time elapsed per square centimeter of the resected lesion was 7.53±6.35 min/cm2in the GTS group and 6.92±5.93 min/cm2in the HKC group(P=0.66).The overall complication rate was not significantly different between the two groups.CONCLUSION:GTS is a safe and effective device for ESD compared with HKC.ESD can be performed with GTS alone,which can reduce the costs for ESD.展开更多
文摘AIM to compare the efficacy and safety of a hook knife(HO) with a hybrid knife(HK) during endoscopic submucosal tunnel dissection(EStD) procedure.METHODS Between August 2012 and December 2015, the ESt D procedure was performed for 83 upper GI submucosal lesions, which originated from the muscularis propria layer identified by upper endoscopy and endoscopic ultrasonography. Of these, 34 lesions were treated by a HO, whereas 49 lesions were treated by a HK. Data regarding age, gender, presenting symptoms, tumor location and size, procedure time, complications, en bloc resection rate and others were analyzed and compared between the two groups.RESULTS there were no significant differences in the age, gender, presenting symptoms and tumor location between the two groups. EStD was successfully completed in all the patients, and no case was converted to laparoscopy. the mean procedure time was significantly shorter in the HK group than in the HO group(41.3 ± 20.3 min vs 57.2 ± 28.0 min, p = 0.004). the mean frequency of device exchange was 1.4 ± 0.6 in the HK group and significantly less than 3.3 ± 0.6 in the HO group(p < 0.001). the differences in tumor size and histopathological diagnoses were not significant between the two groups(p = 0.813, p = 0.363, respectively). Both groups had an equal en bloc resection rate and complete resection rate. Additionally, the complication rate was similar between the two groups(p = 0.901). During the follow-up, no recurrence occurred in either group.CONCLUSION We demonstrate for the first time that HO and HK do not differ in efficacy or safety, but HK reduces the frequency of device exchange and procedure time.
文摘Buried bumper syndrome(BBS) is an uncommon but serious complication of percutaneous endoscopic gastrostomy. It involves the internal fixation device, or "bumper", migrating into the gastric wall and subsequent mucosal overgrowth. We described a case series of four patients with BBS treated with a novel endoscopic technique using a Hook Knife between June 2016 and February 2017. The Hook Knife is a rotating L-shaped cutting wire designed for hooking tissue and pulling it away from the gastric wall towards the lumen. The technique was successful in all four cases with no complications. Each patient was discharged on the day of treatment. The Hook Knife is a manoeuvrable, safe and effective device for endoscopic removal of buried bumpers and could avoid surgery in a high risk group of patients. To our knowledge this technique has not been described previously. We suggest that this technique should be added to the treatment algorithms for managing BBS.
基金Supported by Research grants from Korean Society of Gastrointestinal Endoscopy
文摘AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affiliated to The Catholic University of Korea.ESD was performed in 76 consecutive patients with gastric epithelial neoplasia by using the GTS(37 patients)or the hook knife plus coagrasper(HKC)(39 patients).The complete resection rate,complication rate,total time elapsed and elapsed time per square centimeter of the dissected specimen were analyzed between the GTS and HKC group.RESULTS:The mean age of the GTS group was 62.3±11.4 years and mean age of the HKC group was 65.6±10.1 years.Differentiated adenocarcinoma was found in32.4%in the GTS group and 33.3%in the HKC group.The procedures were performed without interruption in every case in both groups.The en bloc resection rates of both groups were 100%.The total time elapsed during the procedure was 44.54±21.72 min in the GTS group and 43.77±21.84 min in the HKC group(P=0.88)and the time elapsed per square centimeter of the resected lesion was 7.53±6.35 min/cm2in the GTS group and 6.92±5.93 min/cm2in the HKC group(P=0.66).The overall complication rate was not significantly different between the two groups.CONCLUSION:GTS is a safe and effective device for ESD compared with HKC.ESD can be performed with GTS alone,which can reduce the costs for ESD.
