Clin Endosc.  2022 Nov;55(6):775-783. 10.5946/ce.2022.099.

Endoscopic submucosal dissection in colorectal neoplasia performed with a waterjet system-assisted knife: higher en-bloc resection rate than conventional technique

• Cecinato P
• Lucarini M
• Azzolini F
• Campanale M
• Bassi F
• Cippitelli A
• Sassatelli R

• KMID: 2536078
• DOI: http://doi.org/10.5946/ce.2022.099

Abstract

Background/Aims
Colorectal endoscopic submucosal dissection (ESD) is burdened by its associated high risk of adverse events and long procedure time. Recently, a waterjet-assisted knife was introduced to simplify and speed up the procedure. The aim of this study was to evaluate the efficacy and safety of waterjet-assisted ESD (WESD) compared to that of the conventional ESD (CESD) technique.
Methods
The charts of 254 consecutive patients who underwent colorectal ESD between January 2014 and February 2021 for colorectal neoplasms were analyzed. The primary outcome was the en-bloc resection rate. Secondary outcomes were complete and curative resection rates, the need to switch to a hybrid ESD, procedure speed, the adverse event rates, and the recurrence rates.
Results
Approximately 174 neoplasias were considered, of which, 123 were removed by WESD and 51 by CESD. The en-bloc resection rate was higher in the WESD group (94.3% vs. 84.3%). Complete resection rates and curative resection rates were similar. The need to switch to a hybrid ESD was greater during CESD (39.2% vs. 13.8%). Procedure speed and adverse event rates were similar. During follow-up, one recurrence occurred after a WESD.
Conclusions
WESD allows a high rate of en-bloc resections and less frequently requires a rescue switch to the hybrid ESD compared to CESD.

Keyword

Colorectal adenoma; Colorectal cancer; Colorectal endoscopic submucosal dissection; Endoscopic Submucosal Dissection; HybridKnife

Figure

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  Fig. 1. HybridKnife T-type (Erbe Elektromedizin GmbH, Tuebingen, Germany).

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  Fig. 2. Study flowchart. ESD, endoscopic submucosal dissection; WESD, waterjet-assisted ESD; CESD, conventional ESD.

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  Fig. 3. (A–C) Progressive sequences of injection and cutting during the distal incision of a rectal lesion.

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  Fig. 4. Progressive sequences of submucosal injection improving the visualization of the submucosal layer in mild (F1) (A–C) and severe (F2) (D–F) submucosal fibrosis.

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