A new breakthrough: ESD using a newly developed grasping type scissor forceps for early gastrointestinal tract neoplasms

Table 1 Problems during ESD using conventional knives and proposed measures

Problems	Proposed measures
Unintentional incision	Device fixation to the targeted tissue
	Outside insulation
Perforation	Sufficient submucosal injection
	Outside insulation
	Lift up the targeted tissue by device
	Good visualization of the targeted area
Bleeding	Compression of the blood vessel by device

ESD: Endoscopic submucosal dissection.

Table 2 Clinicopathological characteristics (n = 49)

Gender, male/female			32/17
Mean age years (range)			69 (31-87)
Location, n	Esophagus		3
		Middle	1
		Lower	2
	Stomach[17]		35
		Upper	9
		Middle	8
		Lower	18
	Duodenum	Bulbus	1
	Colorectum[18]		10
		Cecum	2
		Ascending	1
		Transverse	2
		Descending	2
		Rectum	3
Histologic type and depth of invasion, n
	Carcinoma		27
		Mucosa	24
		Superficial submucosa	2
		Deep submucosa	1
	Adenoma	Mucosa	20
	Carcinoid tumor	Deep submucosa	1
	Granular cell tumor	Deep submucosa	1

Table 3 Technical results of ESD using GSF (n = 49)

Curative en-bloc resection rate, Total	92% (45/49)
Esophagus	100% (3/3)
Stomach[17]	97% (34/35)
Duodenum	(0/1)
Colon and rectum[18]	80% (8/10)
Mean ± SD operating time, minutes (Range), Total	114.0 ± 63.4 (33-337)
Esophagus	74.7 ± 26.3 (59-105)
Stomach[17]	104.1 ± 54.4 (33-264)
Duodenum	172
Colon and rectum[18]	154.9 ± 83.6 (70-337)
Mean ± SD size of tumor size, mm (Range)	16.6 ± 9.0 (5-43)
Mean ± SD size of resected specimen, mm (Range)	33.0 ± 10.5 (15-60)
Intra-operative perforation rate	0/49 (0%)
Intra-operative major bleeding rate	0/49 (0%)
Postoperative bleeding rate	1/49 (2%)
Postoperative perforation rate	0/49 (0%)

GSF: Grasping type scissor forceps.

Table 4 Theoretical advantages of GSF during ESD

Advantageous mechanism	Expected physical effects	Technical outcome
Grasp	Fix	(1) No unintentional incision
	Lift-up	(2) Good visualization
		(3) Sufficient separation from the underlying proper muscle layer to prevent perforation
	Compress	(4) Hemostatic effect to prevent and treat bleeding
Outside insulation	Closed discharge	(5) Minimizing damage to the surrounding tissue to prevent perforation
Rotatable	Change the direction of grasping	(6) Facilitating accurate targeting