title: The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case-control study.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) using short needle knives is safe and effective, but bleeding is a problem due to low haemostatic capability.
  
  
  OBJECTIVE
  To assess the performance of a novel ball-tipped needle knife (Flush knife-BT) for ESD with particular emphasis on haemostasis.
  
  
  METHODS
  A case-control study to compare the performance for ESD of 30 pairs of consecutive early gastrointestinal lesions (oesophagus: 12, stomach: 32, colorectum: 16) with standard Flush knife (F) vs. Flush knife-BT (BT). Primary outcome was efficacy of intraprocedure haemostasis. Secondary outcomes included procedure time, procedure speed (dividing procedure time into the area of resected specimen), en bloc resection rate and recurrence rate.
  
  
  RESULTS
  Median intraoperative bleeding points and bleeding points requiring haemostatic forceps were smaller in the BT group than in the F group (4 vs. 8, P < 0.0001, 0 vs. 3, P < 0.0001). There was no difference between groups for procedure time; however, procedure speed was shorter in the BT group (P = 0.0078). En bloc and en bloc R0 resection rates were 100%, with no perforation or post-operative bleeding. No recurrence was observed in either group at follow-up 1 year postprocedure.
  
  
  CONCLUSIONS
  Ball-tipped Flush knife (Flush knife-BT) appears to improve haemostatic efficacy and dissection speed compared with standard Flush knife.
authors.affiliation: Department of Endoscopy, Kobe University Hospital, Japan. toyonaga@med.kobe-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Toyonaga
authors.forename: M
authors.initials: M
authors.lastname: Man-I
authors.forename: T
authors.initials: T
authors.lastname: Fujita
authors.forename: E
authors.initials: E
authors.lastname: Nishino
authors.forename: W
authors.initials: W
authors.lastname: Ono
authors.forename: Y
authors.initials: Y
authors.lastname: Morita
authors.forename: T
authors.initials: T
authors.lastname: Sanuki
authors.forename: A
authors.initials: A
authors.lastname: Masuda
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: H
authors.initials: H
authors.lastname: Kutsumi
authors.forename: H
authors.initials: H
authors.lastname: Inokuchi
authors.forename: T
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004210:Dissection / Q000295:instrumentation*; D004724:Endoscopy / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D008297:Male; D013223:Statistics as Topic; D013525:Surgical Instruments / Q000592:standards*; D016896:Treatment Outcome