ENDOSCOPIC SUBMUCOSAL DISSECTION WITH A SCISSOR-TYPE KNIFE: SELECTION OF THE APPROPRIATE SB KNIFE AND TIPS FOR MANIPULATION ACCORDING TO EACH SITUATION (WITH VIDEOS)

Abstract

The Stag Beetle Knife （SB Knife） was put to practical use in 2013 as the first scissors-type knife allowing steady tissue incision for endoscopic submucosal dissection (ESD) in the world. It enables safe and easy resection without the need for large manipulation of the endoscope by grasping the target tissue with the open-close operations of the tip of the knife and applying the high-frequency currentvisually confirming the dissection plane.

Several variations of the SB Knife have been developed including the Jr type and Jr2 type for colorectal ESD, the Short type for exfoliation in esophageal ESD, the Standard type for exfoliation in gastric ESD, the GX type for gastric ESD and the type for Laparoscopy and Endoscopy Cooperative Surgery. These knives are especially useful for handling in the narrow space of the colorectum and esophagus, and in cases associated with severe submucosal fibrosis that mandates more accurate and shaper dissection. These SB knives can overcome situations in which it is difficult to complete ESD with the conventional devices.

The SB Knife will contribute to make ESD procedures globally propagated as a standard therapeutic option. Because it can resect the target tissue without large manipulation of the tip of the endoscope, even novice endoscopists can safely use and handle the SB Knife.