Efficacy and safety of a novel needle-type knife with through the tip of the needle fluid injection compared to a conventional needle-injection knife for colorectal ESD

Introduction: The Tech Knife (TK) is capable of pumping fluid through the tip of the knife. We evaluated the efficacy and safety of TK in colorectal ESD compared with a conventional needle-injection knife.
Methods: This multicenter prospective randomized controlled trial was conducted at 5 Japanese institutions between November 2023-December 2024. Patients with 20-50mm superficial colorectal tumor were enrolled and randomly assigned to TK group or Dual Knife J (DK) group.
Results: TK and DK groups comprised 130 and 125 patients, respectively. There was no difference in procedure time (37.4/26.9 min; P=0.25), dissection speed (37.9/33.3 mm2/min; p=0.21). However, there were significantly fewer intraprocedural device insertions/removals in TK group than in DK group (1.9/3.1; p<0.05). Furthermore, there was significantly fewer total local injection volume in TK group than in DK group (36.1/43.1 mL; p<0.05). In the cases for lesions more than 30mm, there was significantly shorter procedure time (37.8/51.9 min; P<0.05) and faster dissection speed (56.1/41.2 mm2/min; p<0.05) in TK group than in DK group.
Conclusion: TK had similar efficacy and safety compared with DK, however TK may be a more convenient than DK. If limited to colorectal ESD for more than 30mm, TK may shorten procedure time more than DK.