title: An electrosurgical endoknife with a water-jet function (flushknife) proves its merits in colorectal endoscopic submucosal dissection especially for the cases which should be removed en bloc.
abstract: Background. Previously, we reported that the Flushknife (electrosurgical endoknife with a water-jet function) could reduce the operation time of colorectal endoscopic submucosal dissection (ESD) however, suitable situation for the Flushknife was obscure. This subgroup analysis of a prospective randomized controlled trial was aimed to investigate the suitable situation for the Flushknife. Methods. A total of 48 superficial colorectal neoplasms that underwent ESD using either the Flexknife or the Flushknife in a referral center were enrolled. The differences of operation time between the Flexknife and the Flushknife groups in each subgroup (tumor size, location, and macroscopic type) were analyzed. Results. Median (95% CI) operation time calculated using survival curves was significantly shorter in the Flushknife group than in the Flexknife group (55.5 min [41, 78] versus 74.0 [57, 90] min; P = 0.039, Hazard Ratio HR: 0.53; 95% CI (0.29-0.97)). In particular, the HR in patients with laterally spreading tumors-nongranular type (LST-NG) in the Flushknife group was significantly smaller than in the Flexknife group (HR: 0.165→0.17; 95% CI (0.04-0.66)). There was a trend of decreasing HRs according to larger lesion size. Conclusions. The Flushknife proved its merits in colorectal ESD especially for the lesions which should be removed en bloc (LST-NG and large lesion).
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Noboru
authors.initials: N
authors.lastname: Hanaoka
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo