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Updated: Jun 13, 2026
A New Ex Vivo Model for the Evaluation of Endoscopic Submucosal Injection Material Performance
Published on: October 19, 2018
The flushing method: a novel hemostatic technique for endoscopic submucosal dissection in insufflation and
Ryosuke Ishida1, Takashi Toyonaga1, Hiromitsu Ban2
1Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Background And Aims:
Saline-immersion endoscopic submucosal dissection (ESD) offers improved visualization. It may also provide better buoyancy for the tissue to facilitate the dissection. However, achieving reliable hemostasis remains technically challenging. This article presents the "flushing method," a novel hemostatic technique enabling consistent precoagulation and bleeding control under insufflation and immersion conditions.
Methods:
The flushing method was developed by connecting an endoscopic irrigation pump (EIP 2; Erbe Elektromedizin GmbH, Tübingen, Germany) to a FlushKnife BT-S (Fujifilm, Tokyo, Japan) via an extension tube. Pressing the foot pedal activates both the electrosurgical unit and the irrigation pump simultaneously, ejecting saline solution from the base of the knife. This can eliminate the vaporization layer generated by high-frequency coagulation while suppressing the electrical discharge. This allows stable and safe coagulation even at higher-power settings.
Results:
The technique was applied during ESD for a 150-mm circumferential rectal tumor in a 55-year-old woman. A total of 129 vessels (22 branching and 107 penetrating) were precoagulated using forcedCOAG (effect 5.5) with the irrigation pump flushing. Bleeding events (n = 14) were controlled with the knife alone, without hemostatic forceps.
Conclusions:
The flushing method is a safe and effective technique for precoagulation and hemostasis during ESD under both insufflation and saline-immersion conditions. Its versatility may broaden the clinical applicability of ESD.
