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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 10, 2016; 8(3): 122-127
Published online Feb 10, 2016. doi: 10.4253/wjge.v8.i3.122
Use of water jet instruments in gastrointestinal endoscopy
Toru Nakano, Chiaki Sato, Tadashi Sakurai, Takashi Kamei, Atsuhiro Nakagawa, Noriaki Ohuchi
Toru Nakano, Chiaki Sato, Tadashi Sakurai, Takashi Kamei, Noriaki Ohuchi, Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Atsuhiro Nakagawa, Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Author contributions: Nakano T performed the majority of the writing, prepared the figures; Sato C and Nakagawa A prepared the figures; Sakurai T, Kamei T and Ohuchi N coordinated the writing of the paper and reviewed the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toru Nakano, MD, PhD, Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. torun@med.tohoku.ac.jp
Telephone: +81-22-7177214 Fax: +81-22-7177217
Received: April 28, 2015
Peer-review started: May 7, 2015
First decision: September 8, 2015
Revised: November 9, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: February 10, 2016
Abstract

In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects.

Keywords: Endoscopy, Water jet, Endoscopic submucosal dissection, Endoscopic mucosal resection, Pulse

Core tip: This review provides an overview of recent clinical and preclinical studies of water jet instruments in gastrointestinal endoscopy. Water jets have been used to keep the endoscopic view clear which contributed to reduce time and discomfort of endoscopic examination, and the technology provides an alternative method for endoscopic tumor resection. However, continuous flow is used in the transmucosal injection of water into the submucosal layer for elevating the mucosa to prepare for endoscopic mucosal resection. A preclinical study has used a pulsed water jet system as an alternative method to achieve dissection of submucosal layer.