LAUSR

The stability of the endoscope tip is very important in endoscopic submucosal dissection (ESD). Especially in the case of a scissors-type incision device, it is important to be able to insert and remove the device while maintaining the field of view. This study examined gastric ESD using an endoscope holder, the Endo KEYper (Boston Scientific, Marlborough, Massachusetts, USA) (▶Fig. 1, ▶Fig. 2), and a scissors-type incision device, the SB Knife (SB-Kawasumi Laboratories, Inc., Kanagawa, Japan). The Endo KEYper is a device that is fixed to the overtube (top) to prevent the endoscope from falling out, and the endoscope remains stable even when the right hand is removed from the shaft, allowing the device to be inserted and removed with the right hand (▶Fig. 3). The SB Knife was used in nine gastric ESD cases, divided into those with and without the Endo KEYper and those with and without traction [1]. The number of SB Knife detachments per endoscope hold was 1.3 in the three cases without the Endo KEYper, 2.2 in the three cases with the Endo KEYper, and 4.8 in the three cases with the Endo KEYper plus traction. The use of the Endo KEYper enabled continuous dissection by inserting and removing the SB Knife because the endoscope remained in place even when the right hand was released. Furthermore, the traction of the Endo KEYper allowed the dissected surface to expand without the use of a hood, enabling further continuous dissection (▶Video 1). The combination of the Endo KEYper and SB Knife was useful, and the combination with traction was able to reduce the difficulty of ESD.