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

Abstract

AIMTo compare the outcomes of endoscopic submucosal dissection (ESD) for gastric neoplasms using Clutch Cutter (ESD-C) or other knives (ESD-O).METHODSThis was a single-center retrospective study. Gastric neoplasms treated by ESD between April 2016 and October 2017 at Kitakyushu Municipal Medical Center were reviewed. Multivariate analyses and propensity score matching were used to reduce biases. Covariates included factors that might affect outcomes of ESD, including age, sex, underlying disease, anti-thrombotic drugs use, tumor location, tumor position, tumor size, tumor depth, tumor morphology, tumor histology, ulcer (scar), and operator skill. The treatment outcomes were compared among two groups. The primary outcome was ESD procedure time. Secondary outcomes were en bloc, complete, and curative resection rates, and adverse events rates including perforation and delayed bleeding.RESULTSA total of 155 patients were included in this study; 44 pairs were created by propensity score matching. Background characteristics were quite similar among two groups after matching. Procedure time was significantly shorter for ESD-C (median; 49 min) than for ESD-O (median; 88.5 min) (P < 0.01). However, there was no significant difference in treatment outcomes between ESD-C and ESD-O including en bloc resection rate (100% in both groups), complete resection rate (100% in both groups), curative resection rate (86.4% vs 88.6%, P = 0.730), delayed bleeding (2.3% vs 6.8%, P = 0.62) and perforation (0% in both groups).CONCLUSIONESD-C achieved shorter procedure time without an increase in complication risk. Therefore, ESD-C could become an effective ESD option for gastric neoplasms.

Efficacy and timing of gastrografin administration after ileus tube insertion in patients with adhesive small bowel obstruction

“…There were confounding biases between the two study groups, as this was a nonrandomized study. Thus, propensity-score matching analysis, which has been used to compensate for confounding factors, was adopted in this study [10][11][12].…”

“…3 [2][3][4] vs. 3 [2][3] days, P = 0.51; median period of hospital admission: 12.5 [9.25-14] vs. 11 [9][10][11][12][13][14][15] days, P = 0.14). However, the median period of ileus tube intubation was significantly shorter in the NEGA group than in the EGA group (7 [5-8] vs. 5 [4][5][6][7] days, P = 0.007).…”

“…Period of hospital admission, median (days) [IQR] 11 [9][10][11][12][13][14] 12.5 [9.25-14] Adverse event, n (%) 1 (0.7) 1 (1.5) EGA, early gastrografin administration; NEGA, non-early gastrografin administration; IQR, interquartile range P-value was calculated using Fisher's exact test for categorical data. P-value was calculated using the Mann-Whitney U test for continuous data distributed abnormally.…”

Endoscopic submucosal dissection with Clutch Cutter using a large cap‐fitted endoscope

“…Clutch Cutter (CC; Fujifilm, Tokyo, Japan) is a grasping scissor‐type endo‐knife applied to endoscopic procedures, including endoscopic submucosal dissection (ESD) . Grasping and cutting lines can be adjusted by rotating CC.…”

“…grasping scissor-type endo-knife applied to endoscopic procedures, including endoscopic submucosal dissection (ESD). [1][2][3][4] Grasping and cutting lines can be adjusted by rotating CC. However, it is sometimes difficult to rotate CC when in close contact with the lesion during ESD because the cap attached to the endoscope interferes with the rotation of CC because of the small space available in a normal cap.…”