A novel, thin-needle knife with high-pressure waterjet for colorectal underwater endoscopic submucosal dissection...

A novel thin-needle knife with high-pressure waterjet was developed to enhance endoscopic submucosal dissection (ESD) in terms of ease, speed, and safety. We present first clinical results using this new device.

We included consecutive colorectal underwater ESD cases over 27 months at 2 therapeutic endoscopy centers. The new knife (HYBRIDknife flex I-Type, 1.5 mm; ERBE Elektromedizin GmbH, Tübingen, Germany) was used at the examiner's discretion and compared with various conventional low-pressure waterjet knives. All cases treated with the new knife were matched 1:1 with controls using propensity score analysis on the basis of lesion size, location, morphology, vascular pattern, and operator experience.

Forty matched pairs were analyzed. The mean long axis of an ex vivo specimen was 47.2 mm (SD 18.8 mm). Dissection speed was significantly greater with the high-pressure knife (36.7 mm²/min vs 28.2; P < .0001), whereas R0 resection rates were comparable (97.5% vs 95%; P = .8). The benefit appeared more pronounced among less-experienced operators and with technically challenging lesions. Three intraprocedural perforations occurred in the control group only, whereas 1 case of postendoscopic coagulation syndrome was observed in each group.

The high-pressure thin-needle knife appears to improve dissection speed with a favorable efficacy and safety profile.