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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

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    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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A Novel One-Step Knife Approach Can Reduce the Submucosal Injection Time of Endoscopic Submucosal Dissection: A Single-Blinded Randomized Multicenter Clinical Trials

Hyunil Kim1 , Jin Woo Kim1 , Hong Jun Park1,2 , Su Young Kim1 , Hyun-Soo Kim1 , Gwang Ho Baik3 , Sung Chul Park4 , Sang Jin Lee5 , and Tae-Hwa Go6

1Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, 2Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, 3Department of Internal Medicine, Hallym University College of Medicine, 4Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, 5Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung, and 6Department of Biostatistics Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to:Hong Jun Park
ORCID https://orcid.org/0000-0001-9320-9978
E-mail ppakongs@yonsei.ac.kr
Hyunil Kim and Jin Woo Kim contributed equally to this work as first authors.

Received: March 7, 2021; Revised: April 16, 2021; Accepted: April 21, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut and Liver

Published online June 25, 2021

Copyright © Gut and Liver.

Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) is a curative treatment modality for early gastric neoplasms; however, ESD can be a time-consuming process. To overcome this pitfall, we developed the one-step knife (OSK) approach, which combines an endoscopic knife and injection needle on a single sheath. We aimed to evaluate whether this approach could reduce the ESD procedure time.
Methods: This single-blinded randomized multicenter trial at four tertiary hospitals from June 2019 to June 2020 included patients aged 19 to 85 years undergoing ESD. Patients were randomly assigned to two groups (OSK or conventional knife [CK]). The injection time, total procedure time, resected specimen size, submucosal fluid amount, degree of device satisfaction, and adverse events were evaluated and compared between groups.
Results: Fifty-one patients were analyzed (OSK: 25 patients and CK: 26 patients). No baseline differences were observed between groups, with the exception of a higher portion of males in the OSK group. The mean injection time was significantly reduced in the OSK group (39.0 seconds) compared to that in the CK group (87.5 seconds, p<0.001). A decrease of more than 10 minutes in the total procedure time (18.0 minutes vs 28.1 minutes, p=0.055) in the OSK group compared to the CK group was observed. Second-look esophagogastroduodenoscopy revealed two delayed bleeding cases in the OSK group that were easily controlled by endoscopic hemostasis.
Conclusions: OSK reduced the injection time and showed a decrease in total procedure time compared with the CK approach. OSK can be a feasible tool for ESD, especially in difficult cases.

Keywords: Gastric cancer, Endoscopic submucosal dissection, Submucosal injection, Procedure time


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Gut and Liver

Published online June 25, 2021

Copyright © Gut and Liver.

A Novel One-Step Knife Approach Can Reduce the Submucosal Injection Time of Endoscopic Submucosal Dissection: A Single-Blinded Randomized Multicenter Clinical Trials

Hyunil Kim1 , Jin Woo Kim1 , Hong Jun Park1,2 , Su Young Kim1 , Hyun-Soo Kim1 , Gwang Ho Baik3 , Sung Chul Park4 , Sang Jin Lee5 , and Tae-Hwa Go6

1Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, 2Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, 3Department of Internal Medicine, Hallym University College of Medicine, 4Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, 5Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung, and 6Department of Biostatistics Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to:Hong Jun Park
ORCID https://orcid.org/0000-0001-9320-9978
E-mail ppakongs@yonsei.ac.kr
Hyunil Kim and Jin Woo Kim contributed equally to this work as first authors.

Received: March 7, 2021; Revised: April 16, 2021; Accepted: April 21, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) is a curative treatment modality for early gastric neoplasms; however, ESD can be a time-consuming process. To overcome this pitfall, we developed the one-step knife (OSK) approach, which combines an endoscopic knife and injection needle on a single sheath. We aimed to evaluate whether this approach could reduce the ESD procedure time.
Methods: This single-blinded randomized multicenter trial at four tertiary hospitals from June 2019 to June 2020 included patients aged 19 to 85 years undergoing ESD. Patients were randomly assigned to two groups (OSK or conventional knife [CK]). The injection time, total procedure time, resected specimen size, submucosal fluid amount, degree of device satisfaction, and adverse events were evaluated and compared between groups.
Results: Fifty-one patients were analyzed (OSK: 25 patients and CK: 26 patients). No baseline differences were observed between groups, with the exception of a higher portion of males in the OSK group. The mean injection time was significantly reduced in the OSK group (39.0 seconds) compared to that in the CK group (87.5 seconds, p<0.001). A decrease of more than 10 minutes in the total procedure time (18.0 minutes vs 28.1 minutes, p=0.055) in the OSK group compared to the CK group was observed. Second-look esophagogastroduodenoscopy revealed two delayed bleeding cases in the OSK group that were easily controlled by endoscopic hemostasis.
Conclusions: OSK reduced the injection time and showed a decrease in total procedure time compared with the CK approach. OSK can be a feasible tool for ESD, especially in difficult cases.

Keywords: Gastric cancer, Endoscopic submucosal dissection, Submucosal injection, Procedure time

Gut and Liver

Vol.15 No.5
September, 2021

pISSN 1976-2283
eISSN 2005-1212

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