Short abstract
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Brief Explanation
Endoscopic submucosal dissection (ESD) using a scissor‐type knife, the Stag‐Beetle knife (SB knife; Sumitomo Bakelite, Tokyo, Japan), is considered technically easy and safe as a result of its ability to grasp the target tissue to allow controlled resection without the complex endoscopic tip control required with conventional ESD devices. There are two types of SB knife (short‐type and Jr‐type) used mainly for esophageal and colorectal neoplasms.1, 2, 3 Recently, a new type, SB knife GX, has been developed for gastric ESD. The ridged base of the blades helps grasp tissue more tightly. More details about the characteristics of SB knife GX and comparison with another scissor‐type knife, Clutch Cutter (Fujifilm, Tokyo, Japan),4 are described in Video S1.
Gastric ESD in the fornix is considered challenging because it is difficult to maintain the appropriate scope tip position, and the risk of perforation is higher because of the thin wall.5 We present this case of ESD for an early gastric neoplasm in the fornix using the SB knife GX.
A 68‐year‐old man was referred for ESD of a slightly elevated neoplasm (0‐IIa) measuring approximately 10 mm in the fornix of the stomach. After injection of sodium hyaluronate into the submucosa, a mucosal incision was made with the SB knife GX. After circumferential incision, we continued submucosal dissection with the same knife. As the scope tip approached closer to the lesion, it was difficult to achieve an accurate position, but rotation of the knife and its ability to grasp tissue before cutting allowed safe ESD without requiring complex manipulation of the scope tip. In addition, the same knife was used for hemostasis. Histopathological examination showed well‐differentiated tubular adenocarcinoma, and part of the tumor infiltrated the submucosa (SM1/195 μm). This was regarded as curative resection. The patient was discharged later without adverse events.
Authors declare no conflicts of interest for this article.
Supporting information
Video S1 Characteristics of the SB knife GX (Sumitomo Bakelite, Tokyo, Japan) and the endoscopic submucosal dissection (ESD) procedure using the knife for a 10‐mm 0‐IIa lesion in the fornix (fundus) of the stomach.
Acknowledgment
The authors thank Naoko Matsumoto for assistance in data collection and administrative support.
References
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Supplementary Materials
Video S1 Characteristics of the SB knife GX (Sumitomo Bakelite, Tokyo, Japan) and the endoscopic submucosal dissection (ESD) procedure using the knife for a 10‐mm 0‐IIa lesion in the fornix (fundus) of the stomach.