Scissor‐type knife significantly improves self‐completion rate of colorectal endoscopic submucosal dissection: Single‐center prospective randomized trial

Abstract

Background and Aim: Colorectal endoscopic submucosal dissection (C-ESD) is recognized as a difficult procedure. Recently, scissors-type knives were launched to reduce the difficulty of C-ESD. The aim of this study was to evaluate the efficacy and safety of the combined use of a scissors-type knife and a needle-type knife with a water-jet function (WJ needleknife) for C-ESD compared with using the WJ needle-knife alone.Methods: This was a prospective randomized controlled trial in a referral center. Eighty-five patients with superficial colorectal neoplasms were enrolled and randomly assigned to undergo C-ESD using a WJ needle-knife alone (Flush group) or a scissortype knife-supported WJ needle-knife (SB Jr group). Procedures were conducted by two supervised residents. Primary endpoint was self-completion rate by the residents.Results: Self-completion rate was 67% in the SB Jr group, which was significantly higher than that in the Flush group (39%, P = 0.01). Even after exclusion of four patients in the SB Jr group in whom C-ESD was completed using the WJ needle-knife alone, the self-completion rate was significantly higher (63% vs 39%; P = 0.03). Median procedure time among the selfcompletion cases did not differ significantly between the two groups (59 vs 51 min; P = 0.14). No fatal adverse events were observed in either group. Conclusions:In this single-center phase II trial, scissor-type knife significantly improved residents' self-completion rate for C-ESD, with no increase in procedure time or adverse events. A multicenter trial would be warranted to confirm the validity of the present study.

Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study

“…In Western countries, however, ESD is not popular because of technical difficulty, longer procedure time, and higher risk of adverse events than with EMR . Even in Japan, it would be challenging for less‐experienced operators because visualization of appropriate operating site and maintaining good maneuverability are difficult . We therefore developed a novel, simplified traction method—traction‐assisted colorectal ESD using a clip‐and‐thread (TAC‐ESD)—to facilitate colorectal ESD .…”

“…[8][9][10] Even in Japan, it would be challenging for less-experienced operators because visualization of appropriate operating site and maintaining good maneuverability are difficult. 11,12 We therefore developed a novel, simplified traction method-traction-assisted colorectal ESD using a clip-and-thread (TAC-ESD)-to facilitate colorectal ESD. [13][14][15] We reported its feasibility previously.…”

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

“…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.…”

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.…”