Dr. Tsuneo Oyama
Saku Central Hospital
Interview With The Expert
it’s safer than a needle knife because it hooks the mucosa for incision and dissection so it is less invasive for the deeper tissues. The rotary function provides another advantage, the ability to align the knife horizontally or vertically. Marking with the back of HookKnife will reduce the risk of perforation. In addition, safer use is possible by mounting an attachment to the endoscope’s distal end to maintain the field of view and by pulling the mucosa into the attachment before supplying current. The capability to perform dissection by directly observing the submucosal layer enables precoagulation. It is nice to be able to perform dissection with a good view and no bleeding.
it is unavoidable to say that the cutting amount for each time is not plentiful.
The needle knife is convenient because its cutting style is like flicking the tissue. Also ITknife and FlexKnife have a higher vertical incision speed so I sometimes use them instead of HookKnife.
Applicability of HookKnife
Difficulty per region
◯ : Easy. No mark: Ordinary. △ : Difficult.
|Lesser curvature of upper body||◯|
|Greater curvature of upper body||△|
|Anterior wall of upper body|
|Posterior wall of upper body|
|Lesser curvature of middle body||◯|
|Greater curvature of middle body||△|
|Anterior wall of middle body|
|Posterior wall of middle body|
|Lesser curvature of lower body||◯|
|Greater curvature of lower body||◯|
|Anterior wall of lower body||◯|
|Posterior wall of lower body||◯|
|Lesser curvature of anterior wall|
|Greater curvature of antrum||◯|
|Anterior wall of antrum||◯|
|Posterior wall of antrum||◯|
Recommendation for beginners: 1) It is important to begin by observing the experts’ procedures. 2) Start with UL(-) lesion of 2 cm or less.
3) After you experience about 10 cases, observe procedures performed by experts again.
|Intravenous anaesthesia||Premedication||General anaesthesia||Monitoring|
|Used||Midazolam 5 to 7.5 mg
Butorphanol 0.5 mg
|Recommended for a large lesion, a case with scar or a case in the neck region of oesophagus.||Used|
（Olympus Medical Systems）
(Use the back of
the hook part.)
|Make HookKnife retracted to reduce the risk of perforation.||Oesophagus: SoftCoag
|Used||Not used||Oesophagus: 200X dilution / Stomach: 20X dilution. Relatively long lifting time (equivalent to 20% glucose)|
|Sodium retention force.
|Used||Not used||Strongest retention force.|
|The muscle layer is a white cloudy thick wall, while the submucosal layer is transparent. Therefore, the two layers are easy to distinguish. The vessels in the submucosal layer can be observed more transparently when indigo carmine is not used. Also, it dies the incised sample in blue.|
|HookKnife||As the EndoCut mode cuts tissue a little at a time, a serious mistake does not happen even when knife control is inadequate.
AutoCut mode cuts tissue more sharply with less thermal denaturation.
or EndoCut I Effect2
DryCut 60W Effect5
60W Effect 3
120W Effect 3
|HookKnife||Use the hook part to approach perpendicularly toward the proper muscle layer. Use the arm part if approaching in parallel is allowed.||Use distal attachment (D-201).
With distal attachment, dissection by suction technique is possible in the oesophagus.
A clip with attached thread can also be used.
or EndoCut I Effect2
APC mode 60W
10 to 15W
|HookKnife||Approach the back of the knife to the bleeding point and briefly supply current without contact. With ESG-100, avoid using ForcedCoag mode only. Instead, perform pre-coagulation in the SoftCoag mode before cutting in the ForcedCoag mode to prevent bleeding.||SprayCoag
|Coagrasper||If bleeding continues, the grasped positionv may be inappropriate. It is important to try grasping a different position.||SoftCoag
|SoftCoag 80W||SoftCoag 60W|
|HookKnife||Small vessel about 1 mm: Hook and coagulate in the Spray or APC mode.|
|Coagrasper||Large vessel about 2 mm: Grasp with Coagrasper and supply current for 1 or 2 seconds in the SoftCoag mode.|
|Clip suture||Dissect to some extent before clipping to prevent the clip from interfering with subsequent treatment.||Perforation made by HookKnife is about 1 × 3 mm small. A single clip can suture it and air leak is low.|
* May not be available in your area.
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