The clinical efficacy of "water-jet" hemostasis in gastrointestinal endoscopic submucosal dissection

Abstract

Objective: This study aims to evaluate the safety and efficacy of "water-jet" hemostasis during endoscopic submucosal dissection.

Methods: In this prospective single-arm clinical study, 10 patients aged 18-60 years with gastric or intestinal mucosal lesions who were admitted to Fujian Medical University Xiamen Humanity Hospital (Xiamen, P. R. China) between June 2022 and June 2023 and met the absolute indications for endoscopic treatment were finally analyzed. The primary outcomes of this study are the incidence rates of adverse events and R0 resection, and the secondary outcomes are length of hospital stay and short- and long-term outcomes.

Results: Successful hemostasis was achieved in all the included cases. In one case, the "water-jet" hemostasis failed to stop bleeding in one blood vessel, so the hemostatic forceps were used instead. No adverse events occurred in all cases. Pathologic results showed R0 resection in all samples.

Conclusion: The "water-jet" method is safe and feasible for hemostasis in endoscopic submucosal dissection.

Keywords: bleeding; endoscopic submucosal dissection; hemostasis; “water-jet”.

Figure 1.

Knife head diameter and water pump pressure

Figure 2.

Intraoperative hemostasis with pretreatment of free vessels. (A) Submucosal vessels were exposed during lesion dissection. (B) After injecting the submucosa of the lesion using an injection needle, dissociate and uncover all accessible blood vessels during lesion dissection. Moreover, compare the blood vessels to the knife head to determine the thickness of the blood vessels. (C) The knife tip was placed close to the blood vessel, approximately 1 mm apart, and strengthens coagulation and hemostasis while injecting water. (D) Gradual “whity” of the vessels was seen until complete ischemic necrosis, after which the vessels were cut off.

Figure 3.

Intraoperative pretreatment of free blood vessels to stop bleeding. (A) Submucosal blood vessels were exposed when the lesion was dissected. (B) Submucosal water was injected, and the blood vessels were stripped off. The diameter of the blood vessels was measured by comparing them with the knife head. (C) The knife head was positioned close to the blood vessels, approximately 1 mm apart, and water was injected into the blood vessels, strengthening coagulation and stopping blood. (D) The vessels exhibited a gradual and complete “whity” state, and the vessel was cut off.

Figure 4.

Intraoperative hemostasis with pretreatment of free blood vessels. (A) During the dissection of the lesion, the submucosal artery was exposed. (B) The knife was placed close to the vessel and electrocoagulated while injecting water. (C) Gradual “whity” of the artery was seen until complete ischemic necrosis. (D) The vessel was cut.

Figure 5.

Intraoperative hemostasis with pretreatment of free blood vessels. (A) During the dissection of the lesion, the submucosal artery was exposed. (B) After performing submucosal water injection, continuously inject water while coagulating strongly for hemostasis. As the blood vessels gradually turn completely whitish, cut off the blood vessels. (C) During dissection, blood oozed from the vascular plexus, and the blood vessels were treated with electrocoagulation while water was being injected. (D) Vascular complete “whity” state, without an eschar.

Figure 6.

Intraoperative hemostasis of active bleeding. (A) Active bleeding. (B) The water injection port of the cutting knife is injected into the bleeding point, and the blood is cleaned up. (C) The bleeding point is exposed, and the submucosa is raised by water injection at the edge, and the edge is strongly coagulated. (D) The blood vessel is “whity” and the bleeding point is stopped.

Figure 7.

Intraoperative hemostasis of active bleeding. (A) Active bleeding. (B) The water injection port of the cutting knife was inserted into the bleeding point and effectively cleaned it. (C) The bleeding point was exposed, and the submucosa was raised by injecting water at the edge, and the edge was strongly coagulated and stopped bleeding. (D) Vascular complete “whity” state, without an eschar.

Figure 8.

Effect of high-frequency current electrification on endoscopic resection specimens. (A) Tissue basement damage caused by “water injection” hemostasis. (B) Tissue basement damage caused by thermocoagulation forceps hemostasis.