Effects of the combined use of a scissor-type knife and traction clip on endoscopic submucosal dissection of colorectal tumors: a propensity score-matched analysis

Ken Inoue; Naohisa Yoshida; Osamu Dohi; Satoshi Sugino; Shinya Matsumura; Hiroaki Kitae; Ritsu Yasuda; Takahiro Nakano; Kei Terasaki; Ryohei Hirose; Yuji Naito; Takaaki Murakami; Yutaka Inada; Kiyoshi Ogiso; Yukiko Morinaga; Mitsuo Kishimoto; Itoh Yoshito

doi:10.1055/a-1535-0786

Effects of the combined use of a scissor-type knife and traction clip on endoscopic submucosal dissection of colorectal tumors: a propensity score-matched analysis

Endosc Int Open. 2021 Nov 12;9(11):E1617-E1626. doi: 10.1055/a-1535-0786. eCollection 2021 Nov.

Authors

Ken Inoue¹, Naohisa Yoshida¹, Osamu Dohi¹, Satoshi Sugino¹, Shinya Matsumura¹, Hiroaki Kitae¹, Ritsu Yasuda², Takahiro Nakano³, Kei Terasaki⁴, Ryohei Hirose¹, Yuji Naito¹, Takaaki Murakami⁵, Yutaka Inada³, Kiyoshi Ogiso⁶, Yukiko Morinaga⁷, Mitsuo Kishimoto⁷, Itoh Yoshito¹

Affiliations

¹ Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
² Department of Gastroenterology, Nara City Hospital, Nara, Japan.
³ Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan.
⁴ Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita-City, Japan.
⁵ Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan.
⁶ Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan.
⁷ Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.

Abstract

Background and study aims This study evaluated the technical aspects of colorectal endoscopic submucosal dissection (ESD) with the Clutch Cutter (CC) (Fujifilm Co., Tokyo, Japan), a scissor-type knife, and the S-O clip (SO) as a traction clip, and compared the safety and efficacy to ESD using a needle-type knife. Patients and methods This was a single-center retrospective study. In Study 1, we evaluated 125 ESD patients: 60 using the SO and CC (SO group) and 65 using the CC (CC group). In Study 2, we evaluated 185 ESD patients: the CC group (N = 65) and 120 using the Flush knife BT-S (Flush group) (Fujifilm Co., Tokyo, Japan). In both studies, the clinicopathological features and therapeutic outcomes were compared using a propensity score-matched analysis. Results In 36 pairs of matched patients in Study 1, the rates of en bloc resection, R0 resection, perforation, and postoperative bleeding (POB) were 97.2 %, 88.9 %, 2.8 %, and 0 %, respectively, for the SO group and 100 %, 91.7 %, 0 %, and 0 % for the CC group (not significant). The mean procedure time for the SO group among less-experienced endoscopists was significantly shorter than in the CC group (42 vs. 65 minutes, P = 0.036). In 49 pairs of matched patients in Study 2, the rates of en bloc resection, R0 resection, perforation, and POB were 100 %, 95.8 %, 0 %, and 0 %, respectively, for the CC group and 98.0 %, 95.8 %, 0 %, and 2.0 % for the Flush group (not significant). The mean procedure time in the CC group among less-experienced endoscopists was significantly shorter than in the Flush group (52 vs. 67 minutes, P = 0.038). Conclusions CC and the combined use of CC and SO reduced colorectal ESD procedure time among less-experienced endoscopists.

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