Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

Abstract

Background and study aim This study aimed to assess the safety and feasibility of endoscopic submucosal dissection (ESD) using a scissors‐type knife with prophylactic closure using over‐the‐scope clip (OTSC) for superficial non‐ampullary duodenal epithelial tumors (SNADETs). Patients and methods Consecutive patients who underwent ESD for SNADETs >10 mm between January 2009 and July 2019 were retrospectively enrolled. We performed ESD using either a needle‐type knife (Flush Knife‐ESD) or a scissors‐type knife (Clutch Cutter‐ESD). Mucosal defects were prophylactically closed using three methods: conventional clip, laparoscopic closure, or OTSC. Results A total of 84 lesions were resected using the Flush Knife‐ESD and the Clutch Cutter‐ESD (37 and 47 patients, respectively), and conventional clip, laparoscopic closure, and OTSC for mucosal defect closure after ESD were applied in 13, 13, and 56 lesions, respectively. The R0 resection rate was significantly higher in the Clutch Cutter‐ESD than that in the Flush Knife‐ESD (97.9% vs 83.8%, respectively, P = 0.040). The intraoperative perforation rate was significantly lower in the Clutch Cutter‐ESD than in the Flush Knife‐ESD (0% vs 13.5%, respectively, P = 0.014). Complete closure rates of conventional clip, laparoscopic closure, and OTSC were 76.9%, 92.3%, and 98.2%, respectively (P = 0.021); and delayed perforation rates were 15.4%, 7.7%, and 1.8%, respectively (P = 0.092). Conclusions Endoscopic submucosal dissection using a scissors‐type knife with prophylactic OTSC closure is safe and feasible for the low‐invasive treatment of SNADETs.

Ex Vivo Porcine Model Study on the Treatment Outcomes of Scissor-type Knife Versus Needle-type Knife in Endoscopic Submucosal Dissection Performed by Trainees

“…In ESD-S, the scissor-type knife allows the operator to con rm the cutting line after grasping the tissue; if the muscle layer is grasped accidentally, it can be released prior to cutting, thereby preventing muscle injuries. A previous study also reported lower complication rates in ESD-S as compared to in ESD-N [28]. ESD-S offers an advantage in that experts can con rm the cutting line while teaching the ESD procedure to trainees.…”

Feasibility of laparoscopic endoscopic cooperative surgery for non‐ampullary superficial duodenal neoplasms: Single‐arm confirmatory trial

“…Third, we did not compare the outcome of D‐LECS and ESD alone in this study. Recently, the efficacy for preventing perforations after duodenal ESD using endoscopic over‐the‐scope clip and string clip was reported 8–10 . Dohi et al 10 .…”

“…Recently, the efficacy for preventing perforations after duodenal ESD using endoscopic over‐the‐scope clip and string clip was reported 8–10 . Dohi et al 10 . reported a low incidence of 1.8% delayed perforation rate after duodenal ESD with the over‐the‐scope clip.…”

A case of laparoscopy and endoscopy cooperative surgery for circumferential superficial nonampullary duodenal epithelial tumor

“…We incised the mucosa and dissected the submucosal layer using the pocket-creation method with a scissors-type knife (Clutch Cutter; Fujifilm Co, Ltd, Tokyo, Japan), as described previously. 4 We created 2 oral-to-anal submucosal tunnels on the sides of the anterior and posterior walls (Fig. 5).…”