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Efficacy and safety of one-step knife compared to conventional insulated-tip knife for endoscopic submucosal dissection: a preliminary study with prospective data collection and retrospective review

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Abstract

Background

Endoscopic submucosal dissection (ESD) is not as tiresome as gastrectomy, but it is a time-consuming procedure. One-step knife (OSK) is a novel knife that combines a knife for ESD and an injection needle into one sheath. In this study, we aimed to compare the insulated tip type of OSK and conventional knife (CK) in terms of procedure time and complication rate.

Methods

Medical records of patients with ESD using CK between February and September 2020 were retrospectively reviewed. Subsequently, data from patients who underwent ESD using OSK by September 2021 were prospectively collected. Total procedure time, procedure time by location and complication rate in the OSK and CK group were compared.

Results

In the study period, a total of 203 patients (OSK, 102 patients; CK, 101 patients) were analyzed. On multivariate analysis, using CK, body location, resection size ≥ 40 mm, and submucosal fibrosis were associated with longer procedure time. The total procedure time was statistically significantly reduced in the OSK group (median 11 vs. 17 min, p < 0.01). The procedure time for each location was more reduced in the body (median 14 vs. 19 min p < 0.01) than the antrum (median 10 vs. 14 min, p = 0.01) in the OSK group. There was no significant difference in post-ESD bleeding and perforation in the two groups (3.9 vs. 3.9%, p = 0.99 and 1.0 vs. 2.0%, p = 0.56).

Conclusions

OSK significantly reduced the total procedure time of ESD. OSK could be an effective and safe knife for gastric ESD, especially for body lesions.

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Author notes

  1. Dae Gon Ryu and Su Jin Kim shares first author ship.

Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

    Dae Gon Ryu, Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park & Hyeong Seok Nam

  2. Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea

    Cheol Woong Choi

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Correspondence to Cheol Woong Choi.

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Dae Gon Ryu, Su Jin Kim, Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Hyeong Seok Nam, Si Hak Lee, and Sun Hwi Hwang have no conflicts of interest or financial ties to disclose.

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Supplementary file1 (MP4 96348 kb) Supplemental video 1. Endoscopic submucosal dissection using one-step knife

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Ryu, D.G., Kim, S.J., Choi, C.W. et al. Efficacy and safety of one-step knife compared to conventional insulated-tip knife for endoscopic submucosal dissection: a preliminary study with prospective data collection and retrospective review. Surg Endosc 37, 329–336 (2023). https://doi.org/10.1007/s00464-022-09515-0

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