Usefulness of IT knife nano for endoscopic submucosal dissection of large colorectal lesions

Aim : Endoscopic submucosal dissection (ESD) is currently widely conducted for the treatment of early gastrointestinal cancers. Due to the characteristic anatomy of the large intestine, needle-tip type devices such as Dual knife are mainly used in colorectal ESD. On the other hand, the non-needle-tip type IT knife is a unique device with an insulated tip, and has been reported to be safe, efficacious and speedy when used in gastric ESD. A new model of IT knife, IT knife nano, anticipated to be useful for esophageal and colorectal ESD has become available, but its usefulness has not been reported. Therefore, we performed this study to evaluate the usefulness of IT knife nano for ESD of large colorectal lesions. Methods : Previous studies have shown that a tumor size of 40 mm or above significantly prolongs treatment time and is a factor of treatment difficulty. We selected colorectal lesions of 40 mm and above, and compared 32 lesions treated with Dual knife alone before IT knife nano was available (No-IT group) and 40 cases treated with IT knife nano as a second knife after IT knife nano became available (IT group). We assessed en bloc resection rate, complete en bloc resection rate, complication rate and treatment time. Results : The en bloc resection rates in No-IT group and IT group were 100% and 97.5%, respectively, with no significant difference. The respective median treatment time was 70 min and 51 min, and was significantly shortened in IT group (P < 0.05). The respective rates of procedure-related perforation were 3.1% and 0%; in IT group suggesting a tendency of reduced incidence. Conclusion : Use of IT knife nano in ESD for large colorectal lesions achieves the same levels of efficacy and safety as conventional device, with the additional merit of shortening treatment time.