Efficacy of Clutch Cutter for Standardizing Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis

Dohi, Osamu; Yoshida, Naohisa; Terasaki, Kei; Azuma, Yuka; Ishida, Tsugitaka; Kitae, Hiroaki; Matsumura, Shinya; Ogita, Kazuyuki; Takayama, Shin; Mizuno, Naoki; Nakano, Takahiro; Hirose, Ryohei; Inoue, Ken; Kamada, Kazuhiro; Uchiyama, Kazuhiko; Ishikawa, Takeshi; Takagi, Tomohisa; Kishimoto, Mitsuo; Konishi, Hideyuki; Naito, Yuji; Itoh, Yoshito

doi:10.1159/000495287

Cited by 24 publications

(29 citation statements)

References 21 publications

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“…[5][6][7][8][9][10][11] Clutch Cutter, which is a scissors-type electrosurgical knife for ESD, is safe and technically efficient for gastric, esophageal, and colorectal ESD. [12][13][14][15][16][17] ESD using Clutch Cutter was reported to be safe for a few patients of duodenal tumors. 18 To prevent delayed complications, we previously reported the safety and feasibility of laparoscopic closure for the prevention of delayed adverse events after ESD.…”

Section: Introductionmentioning

confidence: 99%

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

Dohi¹,

Yoshida²,

Naito³

et al. 2020

Digestive Endoscopy

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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.

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Section: Introductionmentioning

confidence: 99%

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

Dohi¹,

Yoshida²,

Naito³

et al. 2020

Digestive Endoscopy

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“…Few reports have compared the treatment outcomes of ESD-S performed by trainees with those of ESDs performed by trainees using other endo-knives [29][30][31]. The superiority of the scissor-type knife remains controversial.…”

Section: Discussionmentioning

confidence: 99%

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

Ichijima

Esaki

Yamakawa

et al. 2020

Preprint

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BackgroundTrainee endoscopists find endoscopic submucosal dissection (ESD) for gastrointestinal neoplasms difficult to perform independently; furthermore, there is no consensus on which endo-knife type is the most suitable for them. Therefore, we conducted a prospective study comparing the treatment outcomes of scissor-type and needle-type knives in ESD performed by trainees in an ex vivo porcine model.MethodsAround 22 trainees from 13 institutions, divided into two groups according to their endoscopic experience, performed ESD in a porcine model. Each trainee performed two ESDs under expert supervision: one with a scissor-type knife (ESD-S) and the other with a needle-type knife (ESD-N). The efficacy and safety, including the procedure time and rates of self-completion, en bloc resection, and complications, were compared between ESD-S and ESD-N. ResultsEight trainees had an experience of over 1,000 endoscopies (senior trainee: S-Trainee), whereas the remaining had an experience of less than 1,000 endoscopies (junior trainee: J-Trainee). Among the S-Trainees, no significant differences were observed in any treatment outcome between ESD-S and ESD-N. Among the J-Trainees, the total procedure and mucosal incision times were significantly shorter in ESD-S than in ESD-N [total procedure time: 16.5 min (range: 10.0–31.0) vs. 22.3 min (range: 10.0–38.0), P = 0.018; circumferential incision time: 10.0 min (range: 6-16) vs. 17.0 min (range: 5.0–31.5); P = 0.019]. Regarding complications, muscular injury occurred in two patients during ESD-N performed by J-Trainees; however, no muscular injury occurred during ESD-S.ConclusionsS-Trainees could perform ESD safely in an ex vivo porcine model under expert supervision, regardless of the endo-knife type used. However, the scissor-type knife is desirable if J-Trainees were to perform the ESD procedure.

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“…Clutch Cutter (CC; Fujifilm, Tokyo, Japan) is a grasping scissor‐type endo‐knife applied to endoscopic procedures, including endoscopic submucosal dissection (ESD) . Grasping and cutting lines can be adjusted by rotating CC.…”

Section: Brief Explanationmentioning

confidence: 99%

“…grasping scissor-type endo-knife applied to endoscopic procedures, including endoscopic submucosal dissection (ESD). [1][2][3][4] Grasping and cutting lines can be adjusted by rotating CC. However, it is sometimes difficult to rotate CC when in close contact with the lesion during ESD because the cap attached to the endoscope interferes with the rotation of CC because of the small space available in a normal cap.…”

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Endoscopic submucosal dissection with Clutch Cutter using a large cap‐fitted endoscope

Esaki

Ichijima

Suzuki

2019

Digestive Endoscopy

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Efficacy of Clutch Cutter for Standardizing Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis

Cited by 24 publications

References 21 publications

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

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

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

Endoscopic submucosal dissection with Clutch Cutter using a large cap‐fitted endoscope

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