Successful en bloc resection of superficial esophageal cancer treated by endoscopic submucosal dissection with a splash needle.

enables resection of large or nonlifting gastrointestinal epithelial neoplasms in an en bloc fashion. However, the high fre− quency of complications and the com− plexity of the procedure need to be im− proved [1±4]. In collaboration with the Pentax Corporation, Tokyo, Japan, we have therefore invented a novel electro− surgical knife for ESD, called the splash needle (DN−2618A; Pentax Corp.), which has an ultra−thin short needle with a wa− ter−jet function (l" Fig. 1. The advantages are: (i) the short needle is adjustable in length (maximum 2.5mm); (ii) the thin− ness of the needle (0.3 mm diameter) makes it possible to resect using only co− agulation current from mucosal incision to submucosal dissection, to reduce the risk of heavy bleeding, or to resect shar− ply with minimal tissue damage by using cutting or Endocut current; (iii) the wa− ter−jet function from the knife itself al− lows the endoscopic view field to be kept clean, bleeding vessels to be easily identi− fied, and additional submucosal injection to be done without changing the device. A disadvantage could be that a sharper cut− ting ability could lead to perforation if the knife is used incorrectly. A 64−year−old gentleman with a semicircular non−Lu− gol−staining area diagnosed as squamous cell carcinoma in the lower esophagus was referred for ESD. With a preoperative diagnosis of type 0−IIc intramucosal squa− mous cell carcinoma (m2), 3 cm in size, ESD was performed with a splash needle without complications in an operating time of 65 minutes, in a similar way to that described previously, with some modification [5] (l" Fig. 2, l" Video 1). The main modifications were: 1. A single channel upper GI endoscope with a water−jet system was used (GIF− Q260J; Olympus Medical Systems Co., Ltd., Tokyo, Japan), which connected to a water−jet supplier (OFP; Olympus Medical Systems) containing sterile water to wash out blood and mucus from the target area, to keep the en− doscopic view clean, and to identify bleeding points precisely during the procedure. The knife was connected to another water−jet supplier (SA−P2; Pentax) containing normal saline to make an immediate and sufficient submucosal fluid cushion in the area intended to be cut without changing the device. 2. The following electrocautery settings (VIO 300D; ERBE Elektromedizin, Tü− bingen, Germany) were used: forced coagulation mode (effect 2, output 30 W) for marking and submucosal dis− section, and Endocut Q mode (effect 2, duration 1, interval 3) for circumfer− ential mucosal incision. This case shows that this novel knife unques− tionably has several functional advan− tages which enable a step forward in ESD techniques.