Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer

Abstract

AIMTo evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter (ESDCC) in older patients.METHODSWe reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients (> 80 years, n = 64) and non-older patients (≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status (PS) before and after ESDCC, and financial cost of admission.RESULTSThe older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease (P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients (100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications (i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization (11.4 and 10.7 d, respectively) and financial cost of admission (657040 JPY and 574890 JPY, respectively).CONCLUSIONESDCC has a good clinical outcome in older patients.

Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

“…23 articles were screened by their full-texts and six (15)(16)(17)(18)(19)(20) were excluded with reasons (Table 1). Finally, 17 cohort studies were found to be eligible for inclusion in this review (4,(10)(11)(12)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

“…The review was also unable to differentiate outcomes based on various definitions of elderly (≥65 years, ≥75 years, or ≥80 years). Further, with the publication of several recent studies (10)(11)(12), there is a need for updated evidence on the applicability and safety of ESD in elderly patients. In this context, the current study was designed to compare resection rates, complication rates, and length of hospital stay between elderly and non-elderly patients undergoing ESD for early gastric cancer.…”

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

“…Previous studies have reported that these scissor-type knives reduce the technical difficulty of gastrointestinal ESD 2 3 . Some have found that ESD using the CC is technically more efficient for resecting early gastrointestinal tumors than that using conventional needle-type knives 4 5 6 7 8 . However, other reports have shown that colorectal ESD using a scissor-type knife requires a longer mean procedure time than that with conventional knives 1 4 .…”

Clutch Cutter knife efficacy in endoscopic submucosal dissection for early gastric neoplasms

“…In ESD-C, tissue grasping and lifting were conducted before coagulation or cutting, which could reduce heat conduction to the muscular layer, contributing to the decreased risk of perforation. In terms of safety, it was reported that ESD-C could be preferred over ESD-O for elderly patients with some comorbidities[28]. In the present study, over 90% (46/50 before matching, 41/44 after matching) of patients were aged 65 years or older; furthermore, over 40% (22/50 before matching, 20/44 after matching) of patients were aged 75 years or older.…”