Skip to main content

Advertisement

SpringerLink
Log in

HybridKnife high-pressure glycerol jet injection for endoscopic submucosal dissection increases procedural ease and speed: a randomised study in pigs and a human case series

  • New Technology
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background and aims

Good use of the submucosal space is key during endoscopic submucosal dissection (ESD). High-pressure injection of a long-lasting viscous solution using the HybridKnife water-jet system has been demonstrated to be feasible. We compared jet injection of glycerol and normal saline during pig gastric ESD and assessed its feasibility and efficiency during human ESD.

Materials and methods

A blinded randomised controlled study of ESD with the HybridKnife injecting either a glycerol mixture or normal saline and a prospective human case series were performed. Twenty gastric pig dissections (10/group) and 38 human ESDs along the gastrointestinal tract were performed. Dissection speed, specimen size, procedure duration, rates of en bloc and R0 resection, and rates of bleeding and perforation were prospectively recorded. An evaluation of operator comfort and perceived safety (dissection score) was performed using a visual analogue scale with zero being the worst score and ten the best.

Results

Dissection was significantly more rapid (1.38-fold) with glycerol injection than with normal saline injection (28.94 vs. 20.91 mm2/min; p = 0.037). The dissection score was significantly higher in the glycerol group than in the normal saline group (7.3 vs. 4.7; p = 0.0064). No differences were observed in the rates of en bloc resection, bleeding, or perforation. The 38 human cases along the gastrointestinal tract revealed good results (en bloc resection rate = 100 %, R0 resection rate = 90 %) without any complications.

Conclusion

High-pressure jet injection of glycerol with the HybridKnife for ESD increased the speed and operator comfort of the procedure compared with the use of normal saline, and the procedure was safe and efficient for human ESD. The advantages of using a combination of the HybridKnife system and a viscous glycerol solution will help to spread the use of the ESD technique, particularly in non-Asian countries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cao Y, Liao C, Tan A, Gao Y, Mo Z, Gao F (2009) Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 41:751–757. doi:10.1055/s-0029-1215053

    Article  CAS  PubMed  Google Scholar 

  2. Lingenfelder T, Fischer K, Sold MG, Post S, Enderle MD, Kaehler GFBA (2009) Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection. Surg Endosc 23:1531–1535. doi:10.1007/s00464-009-0433-3

    Article  PubMed  Google Scholar 

  3. Yahagi N, Neuhaus H, Schumacher B, Neugebauer A, Kaehler G, Schenk M, Fischer K, Fujishiro M, Enderle M (2009) Comparison of standard endoscopic submucosal dissection (ESD) versus an optimized ESD technique for the colon: an animal study. Endoscopy 41:340–345. doi:10.1055/s-0029-1214473

    Article  CAS  PubMed  Google Scholar 

  4. Fukami N, Ryu CB, Said S, Weber Z, Chen YK (2011) Prospective, randomized study of conventional versus HybridKnife endoscopic submucosal dissection methods for the esophagus: an animal study. Gastrointest Endosc 73:1246–1253. doi:10.1016/j.gie.2010.12.004

    Article  PubMed  Google Scholar 

  5. Cai M-Y, Zhou P-H, Yao L-Q, Xu M-D, Zhong Y-S, Li Q-L, Chen W-F, Hu J-W, Cui Z, Zhu B-Q (2013) Peroral endoscopic myotomy for idiopathic achalasia: randomized comparison of water-jet assisted versus conventional dissection technique. Surg Endosc. doi:10.1007/s00464-013-3300-1

    PubMed  Google Scholar 

  6. Khashab M, Messallam A, Saxena P, Kumbhari V, Ricourt E, Aguila G, Roland B, Stein E, Nandwani M, Inoue H, Clarke J (2013) Jet injection of dyed saline facilitates efficient peroral endoscopic myotomy. Endoscopy. doi:10.1055/s-0033-1359024

    Google Scholar 

  7. Uraoka T, Fujii T, Saito Y, Sumiyoshi T, Emura F, Bhandari P, Matsuda T, Fu K-I, Saito D (2005) Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 61:736–740

    Article  PubMed  Google Scholar 

  8. Uraoka T, Saito Y, Yamamoto K, Fujii T (2009) Submucosal injection solution for gastrointestinal tract endoscopic mucosal resection and endoscopic submucosal dissection. Drug Des Devel Ther 2:131–138

    PubMed  PubMed Central  Google Scholar 

  9. Fujishiro M, Yahagi N, Kashimura K, Matsuura T, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ichinose M, Omata M (2005) Tissue damage of different submucosal injection solutions for EMR. Gastrointest Endosc 62:933–942. doi:10.1016/j.gie.2005.07.052

    Article  PubMed  Google Scholar 

  10. Jacques J, Sautereau D, Carrier P, Couquet C-Y, Debette-Gratien M, Le-Sidaner A, Tabouret T, Valgueblasse V, Loustaud-Ratti V, Legros R (2015) High-pressure injection of glycerol with HybridKnife for ESD is feasible and increases the ease and speed of the procedure: an in vivo study in pigs and first use in human. Surg Endosc. doi:10.1007/s00464-015-4072-6

    Google Scholar 

  11. Pioche M, Ciocîrlan M, Lepilliez V, Salmon D, Mais L, Guillaud O, Hervieu V, Petronio M, Lienhart I, Adriano J-L, Lafon C, Ponchon T (2014) High-pressure jet injection of viscous solutions for endoscopic submucosal dissection: a study on ex vivo pig stomachs. Surg Endosc. doi:10.1007/s00464-013-3378-5

    PubMed  Google Scholar 

  12. Pioche M, Lépilliez V, Déprez P, Giovannini M, Caillol F, Piessevaux H, Rivory J, Guillaud O, Ciocîrlan M, Salmon D, Lienhart I, Lafon C, Saurin J-C, Ponchon T (2015) High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience. EIO. doi:10.1055/s-0034-1391902

    Google Scholar 

  13. Takeuchi Y, Iishi H, Tanaka S, Saito Y, Ikematsu H, Kudo S-E, Sano Y, Hisabe T, Yahagi N, Saitoh Y, Igarashi M, Kobayashi K, Yamano H, Shimizu S, Tsuruta O, Inoue Y, Watanabe T, Nakamura H, Fujii T, Uedo N, Shimokawa T, Ishikawa H, Sugihara K (2014) Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis 29:1275–1284. doi:10.1007/s00384-014-1947-2

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d’hépato-gastro-entérologie, CHU Dupuytren, 2 Avenue Martin Luther-King, 87042, Limoges, France

    Jérémie Jacques, Paul Carrier, Maryline Debette-Gratien, Tessa Tabouret, Hugo Lepetit, Sophie Geyl, Veronique Loustaud-Ratti, Denis Sautereau & Romain Legros

  2. Service de Biostatistique et Information Médicale Hôpital Saint Louis APHP, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France

    Sebastien Kerever

  3. Laboratoire de recherche et d’analyses de la Haute-Vienne, Avenue du Professeur Joseph de Léobardy, 87005, Limoges, France

    Claude-Yves Couquet

Authors
  1. Jérémie Jacques
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastien Kerever
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Carrier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claude-Yves Couquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maryline Debette-Gratien
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tessa Tabouret
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hugo Lepetit
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sophie Geyl
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Veronique Loustaud-Ratti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Denis Sautereau
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Romain Legros
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jérémie Jacques.

Ethics declarations

Disclosures

Jérémie Jacques, Sébastien Kerever, Denis Sautereau, Paul Carrier, Claude-Yves Couquet, Maryline Debette-Gratien, Tessa Tabouret, Hugo Lepetit, Sophie Geyl, Veronique Loustaud-Ratti, Romain Legros have no conflict of interest. The authors have nothing to disclose. ERBE, Tübingen, Germany, provides HybridKnifes, VIO 300D and ERBEJET 2 system free of charge. Karl Stortz Endoscopy, Tuttlingen, Germany, provides upper gastrointestinal endoscope Karl Stortz 13821PKS, and video-processor 22203011-114 free of charge.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jacques, J., Kerever, S., Carrier, P. et al. HybridKnife high-pressure glycerol jet injection for endoscopic submucosal dissection increases procedural ease and speed: a randomised study in pigs and a human case series. Surg Endosc 30, 3152–3159 (2016). https://doi.org/10.1007/s00464-015-4554-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4554-6

Keywords

Search

Navigation