Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: short- to long-term outcomes

Abstract

Endoscopic submucosal dissection (ESD) for colorectal neoplasms remains challenging because of technical issues imposed by the complex anatomical features of the large intestine. We evaluated the feasibility, and the short- and long-term clinical outcomes of ESD for early colorectal neoplasms performed using the Stag-beetle Knife Jr. (SB Knife Jr.) We retrospectively assessed 228 patients who underwent ESD for 247 colorectal lesions with the SB Knife Jr. Clinicopathological characteristics of the neoplasms, complications, and various short- and long-term outcomes were evaluated. Mean tumor size was 34.3 mm and median procedure time was 76 minutes. The SB Knife Jr. achieved 98.4 % en bloc resection, 93.9 % complete resection, and 85.4 % curative resection. No perforations occurred during the procedure, and a delayed bleeding rate of 2.4 % was observed. Long-term outcomes were favorable with no distant recurrence, 1.1 % local recurrence, a 5-year overall survival rate of 94.1 % and 5-year tumor-specific survival rate of 98.6 % in patients with cancer. ESD using the SB Knife Jr. is technically efficient and safe in treating early colorectal neoplasms and is associated with favorable short- and long-term outcomes.

Endoscopic submucosal dissection of a large cecal polyp using a scissor-type knife: implications for training in ESD

“…Recently, this knife became available in the United States. Multiple studies have demonstrated the safety and efficacy of this knife in colorectal ESD, 1 , 2 its ability to overcome challenging situations, 3 and its potential benefits in ESD training. 4 In this case, the stability and ease of use of this knife allowed most of the procedure to be successfully performed by an advanced endoscopy fellow under close supervision from a recognized ESD expert, with the expert performing the most challenging and critical aspects of submucosal dissection.…”

Endoscopic submucosal dissection of colorectal tumors using a novel monopolar scissor‐type knife “SB Knife Jr.2”

“…Both blades of the knife are insulated and allow grasping of tissue, thereby facilitating controlled dissection and potentially preventing unexpected injury to the muscular layer (Fig. a) . When it is used for large lesions during ESD, there are limitations regarding its incision ability, because the frequency of switching/energization increases.…”

Endoscopic submucosal dissection of early gastric neoplasms in the fornix using the newly developed scissor‐type SB knife GX

“…Endoscopic submucosal dissection (ESD) using a scissor‐type knife, the Stag‐Beetle knife (SB knife; Sumitomo Bakelite, Tokyo, Japan), is considered technically easy and safe as a result of its ability to grasp the target tissue to allow controlled resection without the complex endoscopic tip control required with conventional ESD devices. There are two types of SB knife (short‐type and Jr‐type) used mainly for esophageal and colorectal neoplasms . Recently, a new type, SB knife GX, has been developed for gastric ESD.…”