Comparison of Needle Knife versus Scissors Forceps for Colorectal Endoscopic Submucosal Dissection: A Prospective Randomized Study

Author:

Yachida Tatsuo12,Kobara Hideki1,Kozuka Kazuhiro1,Nakatani Kaho1,Tada Naoya1,Matsui Takanori1,Chiyo Taiga1,Kobayashi Nobuya1,Fujihara Shintaro1,Nishiyama Noriko1,Kondo Akihiro3,Ando Yasuhisa3,Okano Keiichi3ORCID,Nonaka Wakako2,Ishikawa Kaori2,Masugata Hisashi2,Masaki Tsutomu1

Affiliation:

1. Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan

2. Department of General Internal Medicine, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan

3. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan

Abstract

Background and Aim: To evaluate the efficacy and safety of a grasping-type knife, called Clutch Cutter (CC), for colorectal endoscopic submucosal dissection (C-ESD). Methods: This was a randomized prospective study. Patients who underwent C-ESD for colorectal neoplasms >20 mm and <50 mm in size were enrolled, dividing into two groups: ESD using needle type of dual knife alone (D-group) and circumferential incision using dual knife followed by submucosal dissection using CC (CC-group). The primary outcome was the self-completion rate. The secondary outcomes were intraoperative complication rate, procedure time, and en bloc resection rate. Results: A total of 45 patients were allocated to the D-group and 43 to the CC-group were allocated. The self-completion rate was higher in the CC-group (87% [39/45] vs. 98% [42/43]). All of the six patients with an incomplete procedure in the D-group were completely resected with CC use. The intraoperative complication rate was not significant in either group (D vs. CC: 2% vs. 0%). The mean procedure time was significantly shorter in the D-group than that in the CC-group (62.0 vs. 81.1 min; p = 0.0036). The en bloc resection rate was 100% in the D-group and 98% in the CC-group. Conclusions: While dual knife use is superior to CC in terms of time efficiency, the use of CC may be a safe and efficacious option for achieving complete C-ESD.

Publisher

MDPI AG

Subject

General Medicine

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