title: Comparison of O-Type HybridKnife to Conventional Knife in Endoscopic Submucosal Dissection for Gastric Mucosal Lesions.
abstract: Endoscopic submucosal dissection (ESD) has been accepted as a minimal invasive alternative to surgery for localized superficial gastrointestinal neoplasms recently. However, the procedure remains to be technically challenging and time consuming. A new dissecting knife with partially insulated tip has been recently developed with built-in injection capability. The purpose of this study was to investigate whether the efficiency of ESD procedure could be improved with this new device. A total of 78 patients, who underwent ESD with gastric mucosal lesions including flat type polyps, adenoma or early gastric cancer, were randomly assigned to either ESD with O-type HybridKnife or conventional ESD knives without waterjet. Procedure time and related factors of ESD were analyzed. ESD procedure time was 43.0 (interquartile range, IQR 27.0-60.0) minutes in HybridKnife group compared to 60.5 (IQR 44.0-86.3) minutes in the control group (P = 0.001). There was no difference in the clinical outcome and the adverse event rate. The former demonstrated more favorable results in lesions ≤4 cm of specimen size (P ≤ 0.0001) and when located in the distal stomach (P = 0.001), also in lesions with fibrosis (P = 0.008). Multivariate regression analysis showed that O-type Knife (P ≤ 0.0001), specimen size (P ≤ 0.0001), and fibrosis (P ≤ 0.0001) were independent predictors of procedure time. The O-type HybridKnife yielded faster procedure time compared to the conventional knives in gastric ESD with a similar safety profile.
authors.affiliation: From the Xijing Hospital of Digestive Diseases, Fourth Military Medical University (RH, GR, YP, LZ, ZL, XG, KW), and The First Affiliated Hospital of Xi'an Medical University, Xi'an, China (HY).
authors.forename: Rui
authors.initials: R
authors.lastname: Huang
authors.forename: Honglin
authors.initials: H
authors.lastname: Yan
authors.forename: Gui
authors.initials: G
authors.lastname: Ren
authors.forename: Yanglin
authors.initials: Y
authors.lastname: Pan
authors.forename: Linhui
authors.initials: L
authors.lastname: Zhang
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Liu
authors.forename: Xuegang
authors.initials: X
authors.lastname: Guo
authors.forename: Kaichun
authors.initials: K
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection / Q000295:instrumentation*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*