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

• Published in: Journal of clinical medicine Vol. 12; no. 6; p. 2329
• Main Authors: Yachida, Tatsuo, Kobara, Hideki, Kozuka, Kazuhiro, Nakatani, Kaho, Tada, Naoya, Matsui, Takanori, Chiyo, Taiga, Kobayashi, Nobuya, Fujihara, Shintaro, Nishiyama, Noriko, Kondo, Akihiro, Ando, Yasuhisa, Okano, Keiichi, Nonaka, Wakako, Ishikawa, Kaori, Masugata, Hisashi, Masaki, Tsutomu
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 16.03.2023; MDPI
• Subjects: Care and treatment; Clinical medicine; Colorectal cancer; Diagnosis; Dissection; Dosage and administration; Endoscopy; Hyaluronate sodium; Knives; Patient outcomes; Patients; Tumors; Japan; United States > US; endoscopic knife; colorectal endoscopic submucosal dissection
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12062329

To evaluate the efficacy and safety of a grasping-type knife, called Clutch Cutter (CC), for colorectal endoscopic submucosal dissection (C-ESD). 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. 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; = 0.0036). The en bloc resection rate was 100% in the D-group and 98% in the CC-group. 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.