Flushナイフによる食道ESD

Esophageal Endoscopic Submucosal Dissection Using the FlushKnife-Efficiency in Creating the Submucosal Groove and Tunnel Method with Additional Injection from the Knife

要旨　Flushナイフは送水機能付きのショートニードルナイフである．シース先端および辺縁をプロテクターとして用いることで切開・剥離ともに連続した操作が可能である．食道では2mmタイプを用い，まず口側の横切開から肛門側横切開までCの字を書くように粘膜切開を行う．次いで切開縁のトリミングを行い同部粘膜下層を溝状に剥離する．水没しやすい場合はさらに溝を広げ水没領域から脱しておく．次いで反対側の粘膜切開とトリミングを終え，剥離操作に移る．剥離も2mmタイプを使用し，困難局面では1mmタイプが有用である．通常追加局注はナイフからの送水で十分であるが，シリンジを用いてヒアルロン酸ナトリウムをナイフから注入することも可能である．2/3周を越えるような病変はトンネル法の併用が有効で，送水による鈍的剥離を利用することで効率的なトンネル形成が可能である．食道はFlushナイフの有用性が顕著な臓器である．

　The Flush Knife is a characteristic water jet short needle knife with a needle of 0.5 mm in diameter and 5 projecting parts of 1, 1.5, 2, 2.5 and 3 mm in length. Protecting the lesion and the muscle layer with the tip part of the sheath, operators can successively perform the mucosal incision and submucosal dissection. In the esophagus, at first, mucosal incision is performed with the 2mm type, to write a character “C" from the oral side to the anal side. Next, the border of the incision is trimmed and the submucosal layer is dissected in the shape of a groove. When the lesion is easy to flood with water, the groove is furthermore enlarged to drain the submerged area. Subsequently, when the mucosal incision and trimming of the other side is finished, the submucosal dissection is started. The 2mm type is also used for the submucosal dissection, and 1mm type is efficient in difficult situations. The jet of water from the tip of the knife is usually enough for the additional injection, and the injection of sodium hyaluronate from a knife with a manual syringe is also valuable. The combination of the tunneling work is useful for lesions exceeding 2/3 of the circumference. The effective tunnel creation is possible because of the dull dissection with the water jet. The esophagus is the organ in which the utility of the Flush knife is most offensive.