Efficacy of scissor‐type knives for endoscopic mucosal dissection of superficial gastrointestinal neoplasms

Abstract

Endoscopic submucosal dissection (ESD) for superficial gastrointestinal neoplasms has become widespread. However, certain aspects of the procedure remain difficult to manage, such as intraoperative bleeding and perforation. There are two kinds of scissor‐type knife: the Clutch Cutter (Fujifilm Co., Tokyo, Japan) and the SB knife (Sumitomo Bakelite Co., Tokyo, Japan). These knives have different features from other types of ESD knives and enable the performance of all ESD procedures, including mucosal incision, submucosal dissection, and hemostasis. The standard approach with scissor‐type knives involves first grabbing the tissue and then incising or dissecting it. Theoretically, perforation as a result of unintentional movement should never happen with scissor‐type knives compared to needle‐ or blade‐type knives, which may induce perforation through unintentional movement. Moreover, the rates of severe bleeding and self‐completion of ESD with scissor‐type knives by non‐experts were reported to be significantly better than for other knives. Thus, scissor‐type knives can resolve these problems and help to further standardize ESD globally. In this review, we summarize reports on the efficacy of such scissor‐type knives for ESD of gastrointestinal tumors. We also present the pocket‐creation method and the application of traction devices, such as dental floss and S‐O clips (Zeon Medical Co., Tokyo, Japan) for improving the performance of ESD with a Clutch Cutter.

Learning curve for endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: use of the cumulative sum method

“…In addition, the considerably low rate of adverse events in the introductory period suggests that the procedure is easy and safe. These results are similar to those reported previously with scissor-type knives and indicated that CR-ESD using SB Knife Jr resulted in good short-term outcomes [2][3][4][5][6][10][11][12][13]. Although positive outcomes with CR-ESD have been reported in high-volume centers in Asia (notably Japan) [14][15][16][17][18][19], the adoption of CR-ESD has not been widespread in general hospitals because of the technical challenges posed by the complex anatomic features of the large intestine.…”

“…In addition, although CR-ESD using the scissor-type knife is gradually increasing, penetration rates remain low. Our previous study included 247 cases [4], and this sample size was the largest among all studies previously conducted on CR-ESD using scissor-type knives [13]. Furthermore, few previous reports for CR-ESD using SB knife Jr exist in Western countries [27].…”

Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

“…[5][6][7][8][9][10][11] Clutch Cutter, which is a scissors-type electrosurgical knife for ESD, is safe and technically efficient for gastric, esophageal, and colorectal ESD. [12][13][14][15][16][17] ESD using Clutch Cutter was reported to be safe for a few patients of duodenal tumors. 18 To prevent delayed complications, we previously reported the safety and feasibility of laparoscopic closure for the prevention of delayed adverse events after ESD.…”

Precut fistulotomy using scissor‐type endoscopic submucosal dissection knife

“…We have developed a precut method using the Clutch Cutter (CC; Fujifilm, Tokyo, Japan). The CC is scissor‐type knife for endoscopic submucosal dissection (ESD) and allows a stable endoscope position during the procedure 5 . Its ability to grasp and release tissue solves many difficulties that face NKF.…”