Usefulness of detection of bleeding sites using the system of squirting water

Bleeding from cutting sites during endoscopic submucosal dissection (ESD) against gastric tumors is inevitable and it is also one of the major complications of ESD. In such cases, detection of bleeding sites and endoscopic hemostasis during ESD could be performed more easily by squirting water. However, conventional endoscopes except from Pentax Co. do not have any water jet system. Therefore, to detect bleeding sites, procedure of squirting water should be performed each time after pulling devices for ESD out of the accessory channel. However, this procedure is very complicated and wastes time. Thus, we developed useful endoscopic hemostatic device during ESD. A probe/irrigation plug was attached to the accessory channel of the endoscope, and water jet system with a foot switch (Water Pik, Water Pik Technologies) was attached to this plug. So that squirting water was able to be performed through the accessory channel even if the needle knife was passed through it. By using this system, it was able to detect bleeding sites and to do endoscopic hemostasis more easily and quickly. Squirting water was also able to be performed even if the hemostatic hotbiopsy forceps was passed through it. Accordingly, this system was thought to be useful for endoscopic hemostasis during ESD against gastric tumors.