The flushing method: a novel hemostatic technique for endoscopic submucosal dissection in insufflation and saline-immersion conditions

Q3 Medicine

VideoGIE Pub Date : 2026-06-01 Epub Date: 2025-12-26 DOI:10.1016/j.vgie.2025.12.006

Ryosuke Ishida MD , Takashi Toyonaga MD, PhD , Hiromitsu Ban MD , Noriko Suzuki MD, PhD , Douglas Motomura MD , Hirofumi Abe MD, PhD , Tetsuya Yoshizaki MD, PhD , Yuzo Kodama MD, PhD

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引用次数: 0

Abstract

Background and Aims

Saline-immersion endoscopic submucosal dissection (ESD) offers improved visualization. It may also provide better buoyancy for the tissue to facilitate the dissection. However, achieving reliable hemostasis remains technically challenging. This article presents the “flushing method,” a novel hemostatic technique enabling consistent precoagulation and bleeding control under insufflation and immersion conditions.

Methods

The flushing method was developed by connecting an endoscopic irrigation pump (EIP 2; Erbe Elektromedizin GmbH, Tübingen, Germany) to a FlushKnife BT-S (Fujifilm, Tokyo, Japan) via an extension tube. Pressing the foot pedal activates both the electrosurgical unit and the irrigation pump simultaneously, ejecting saline solution from the base of the knife. This can eliminate the vaporization layer generated by high-frequency coagulation while suppressing the electrical discharge. This allows stable and safe coagulation even at higher-power settings.

Results

The technique was applied during ESD for a 150-mm circumferential rectal tumor in a 55-year-old woman. A total of 129 vessels (22 branching and 107 penetrating) were precoagulated using forcedCOAG (effect 5.5) with the irrigation pump flushing. Bleeding events (n = 14) were controlled with the knife alone, without hemostatic forceps.

Conclusions

The flushing method is a safe and effective technique for precoagulation and hemostasis during ESD under both insufflation and saline-immersion conditions. Its versatility may broaden the clinical applicability of ESD.

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冲洗法：一种新的止血技术，用于内镜下粘膜下夹层的充气和盐水浸泡条件

背景和目的：盐水浸泡内镜粘膜下剥离（ESD）改善了视觉效果。它也可以为组织提供更好的浮力，以促进剥离。然而，实现可靠的止血在技术上仍然具有挑战性。本文介绍了“冲洗法”，这是一种新的止血技术，可以在充气和浸泡条件下进行一致的预凝和出血控制。方法将内镜冲洗泵（EIP 2; Erbe Elektromedizin GmbH, t宾根，德国）与FlushKnife BT-S （Fujifilm, Tokyo, Japan）通过加长管连接，建立冲洗方法。踩下脚踏板同时激活电手术装置和冲洗泵，从刀的底部喷出盐水溶液。这样可以消除高频混凝产生的汽化层，同时抑制放电。这允许稳定和安全的凝血，即使在较高的功率设置。结果该技术应用于55岁女性直肠周围150 mm肿瘤的ESD治疗。采用强制coag预凝129条血管，其中分支血管22条，穿透血管107条，效果5.5。出血事件（n = 14）仅用刀控制，不使用止血钳。结论冲洗法是一种安全、有效的ESD预凝止血方法。它的多功能性可以拓宽ESD的临床应用范围。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.