Introducing the next evolution of the small-caliber-tip transparent hood: enhancing the pocket-creation method by building on previous successes
Notice bibliographique
Résumé
The pocket-creation method facilitates the procedure of endoscopic submucosal dissection (ESD) and results in high-quality resected specimens with thick and minimally burned submucosa [ 1 ] [ 2 ] [ 3 ] [ 4 ]. The small-caliber-tip transparent hood (ST hood; Fujifilm, Tokyo, Japan) is an essential component of the pocket-creation method, with a conical shape that allows the endoscope tip to enter into the submucosal space quickly and easily [ 5 ]. The small-caliber-tip transparent hood provides both traction and countertraction, stretching the submucosa and allowing it to be easily cut with minimal thermal damage. The previous conventional (DH-15GR; Fujifilm) and short small-caliber-tip transparent hoods (DH-28GR; Fujifilm) each had their own advantages and disadvantages. However, the latest hood of this type (DH-33GR; Fujifilm), launched in Japan in June 2019, incorporates the best qualities of both ([ Fig. 1 ], [ Table 1 ]). Features of this latest hood include: 1) a small, 7-mm diameter orifice; 2) an inner guiderail directing the tips of inserted devices to the center of the endoscopic view (similar to the conventional model); 3) a shorter, 7-mm conical protrusion; 4) double slits facilitating drainage of internal fluid; 5) an easy-to-attach silicon cylindrical base (similar to the short small-caliber-tip transparent hood); and 6) a redesigned proximal guiderail ([ Fig. 2 ]). Fig. 1 The latest small-caliber-tip transparent hood (DH-33GR) with small-diameter opening, short conical protrusion, double drainage slits, redesigned guiderail, and easy-to-attach silicon cylindrical base. Table 1 Dimensions of the small-caliber-tip transparent hoods. Latest model (DH-33GR) Short model (DH-28GR) Conventional model (DH-15GR) Base outer diameter, mm 11.8 11.8 12.2 Tip opening diameter, mm 7.0 8.0 7.0 Protrusion length, mm 7.0 7.0 8.3 Fig. 2 Comparison of proximal guiderail edges between the latest small-caliber-tip transparent hood (left, DH-33GR) and the conventional hood (right, DH-15GR). With the previous conventional hood, inserted instruments could become trapped if 1) they did not emerge perfectly straight from the working channel, or 2) the guiderail did not align with the working channel of the endoscope. In the latest design, the proximal guiderail edge is wider, solving these issues . A 40-mm, Paris IIa, laterally spreading lesion in the distal rectum was removed using the pocket-creation method with the latest small-caliber-tip transparent hood ([ Fig. 3 ], [ Video 1 ]). Like the conventional model, the newest hood easily enters into the submucosa. The 7-mm length of the conical protrusion creates closer views in front of the hood. The redesigned guiderail edge facilitates the smooth insertion of hemostatic forceps, with little resistance. The lesion was removed without any adverse events. Pathology revealed a high-grade adenoma with negative vertical and lateral margins. Fig. 3 a 40-mm, Paris IIa, granular, JNET 2A, Kudo’s type IV pit pattern, laterally spreading lesion in the distal rectum, sprayed with indigo carmine. b The newest model of the transparent small-caliber-tip transparent hood easily enters the submucosa after initial mucosal incision (similarly to the conventional hood). c When the transparent walls of the hood touch the surrounding tissue, light refraction disappears, providing a wide, clear field of view. The short conical protrusion provides closer views of tissue at the front of the hood, magnifying its appearance at the orifice. The submucosa can be examined at a close distance, making it easier to distinguish submucosa from muscularis propria and to identify blood vessels. d The guiderail guides the knife tip to the center of the endoscopic view, eliminating the need to rotate the endoscope to the 6 o’clock/working channel position. e Unlike the conventional small-caliber-tip transparent hood, the redesigned guiderail, with a larger proximal edge, allows easier insertion of hemostatic forceps without getting stuck at the edge. f The submucosal pocket is opened after dissection of the entire underlying submucosa of the lesion. g The defect post-endoscopic submucosal dissection with only minimal burning of the submucosa covering the surface of the muscularis propria. h Resected specimen sprayed with indigo carmine. Pathology revealed a high-grade adenoma with negative vertical and lateral margins. Video 1 Demonstration of pocket-creation method using the small-caliber-tip transparent hood. Quality: mobile 360 480 720 Download In conclusion, the newest small-caliber-tip transparent hood possesses the best qualities of both previous hoods and enhances the performance of the pocket-creation method. Endoscopy_UCTN_Code_TTT_1AQ_2AD Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos Publication History Article published online: 17 February 2020 © Georg Thieme Verlag KG Stuttgart · New York
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,004 | 0,008 |
| Science ouverte | 0,003 | 0,004 |
| Intégrité de la recherche | 0,003 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».