Needle Knife and Water Jet Combined As a Hybrid Knife - A Comparison with Standard Knife in An In Vivo Animal Study

Abstract

Background: Safety and Efficiency of endoscopic submucosal dissection (ESD) crucially depend on an abundant submucosal cushioning and a controlled cutting technique. After showing the ability of Erbe WaterJet Technology (Erbe Eletromedizin Tübingen, Germany) to achieve a submucosal elevation by water injection our study group designed a Hybridknife. This combines a Needle knife with the abilities of a Radiofrequency driven Standard knife (marking, cut and coagulation) with a water jet generator (dyeing, lifting, irrigation and selective tissue elevation) in one instrument. Methods: In 6 mini pigs EGD under general anesthesia was carried out. Square areas of 4 × 4 cm size in the anterior and posterior gastric wall had been marked, elevated by conventional injection. Resection was done with the Hybrid knife either with or without (i.e. Standard ESD) use of Erbe WaterJet. Time of procedure, number of change of instruments, number of bleedings und injuries of the gastric were documented. The examiner rated the procedure subjectively. Results: The resected specimen had the same size 16,9 cm2 (Erbe WaterJet) resp. 15,85 cm2 (Standard ESD). The bleeding rate (2,83 vs. 3,5) and also the number of injuries of the muscular layer (0,17 vs. 1,0) and the shorter procedure time (47.2 min vs. 58.3 min) demonstrated advantages for the Hybrid knife with the simultaneous use of the Water-Jet-Technology. Discussion: The combination of a needle knife with the WaterJet-Technology improves the results of endoscopic submucosal dissection. The number of registered bleedings and injuries is still high in the special setting of a pig model. This on the one side reflects the fact of a learning curve on the other side already intiated further technical improvements of the herein presented new instrument and accompanied Technology.