Adaptive Use of ITknife nano and DualKnife J in Colorectal ESD​

Case Description: Large tubullovillous adenoma lesion, located in caecum, size 41×36×8 mm

Mucosal Pocket Creation with ITknife nano

✔　After conducting mucosal cutting and dissection with the DualKnife J, I switched to the ITknife nano as the approach was perpendicular to
the muscularis propria.

✔　After trimming, a submucosal pocket was created successfully with the ITknife nano.

Managing Large Fibrotic Lesion using Two Types of Knives

✔　After widening the mucosal pocket with the ITknife nano, circumferential incision was continued with the DualKnife J.

✔　The dissection edge of the lesion was effectively managed with the ITknife nano.

✔　In the final stage of the dissection, the approach to oral side of lesion became challenging and the severe fibrosis made dissection difficult.
Nevertheless, resection was completed by opening a pocket with the ITknife nano.

Case Description: Anal lesion extending into the anal canal

Application of “2 Knives Technique” for Challenging Lesion

✔　Approach into the submucosal layer was difficult and the procedure was challenging due to bleeding. The incision was carefully advanced
with controlled bleeding using the DualKnife J.

✔　Dissection in retroflex position was enabled with the DualKnife J.

✔　Because the angulation turned out to be quite difficult, we switched to the ITknife nano, and resection was continued safely.

✔　Despite the challenging characteristic of the lesion, the procedure was completed with a tailored approach by switching the DualKnife J
and the IT knife.