Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Clutch Cutter knife efficacy in endoscopic submucosal dissection for early gastric neoplasms
Yasuyo Hayashi, Mitsuru Esaki, Sho Suzuki, Eikichi Ihara, Azusa Yokoyama, Seiichiro Sakisaka, Taizo Hosokawa, Yoshimasa Tanaka, Takahiro Mizutani, Shinichi Tsuruta, Aya Iwao, Shun Yamakawa, Akira Irie, Yosuke Minoda, Yoshitaka Hata, Haruei Ogino, Hirotada Akiho, Yoshihiro Ogawa
Yasuyo Hayashi, Mitsuru Esaki, Eikichi Ihara, Yosuke Minoda, Yoshitaka Hata, Haruei Ogino, Yoshihiro Ogawa, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Yasuyo Hayashi, Azusa Yokoyama, Seiichiro Sakisaka, Taizo Hosokawa, Yoshimasa Tanaka, Takahiro Mizutani, Hirotada Akiho, Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu 802-0077, Japan
Mitsuru Esaki, Sho Suzuki, Aya Iwao, Shun Yamakawa, Akira Irie, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Itabashi-ku 173-8610, Japan
Shinichi Tsuruta, Department of Anatomic Pathology, Graduate School of Medical Sciences Kyushu University, Fukuoka 812-8582, Japan
Author contributions: Hayashi Y and Esaki M designed the research, drafted the article and revised the article for important intellectual content; Yokoyama A, Sakisaka S, Hosokawa T, Tanaka Y, Mizutani T and Ogino H analysised and interpreted the data; Suzuki S, Iwao A, Yamakawa S, Irie A, Minoda Y, Hata Y, Akiho H and Ihara E critical revised of the manuscript for important intellectual content; Ogawa Y supervised the whole process; all authors have read and approved the final version to be published.
Institutional review board statement: This study was conducted according to the ethical principles of the Declaration of Helsinki, and each institution’s review board and ethical committee approved the study’s protocol.
Informed consent statement: The patients had signed the informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Mitsuru Esaki, MD, Doctor, Research Associate, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchikami-cho, Tokyo, Itabashi-ku 173-8610, Japan. esaki_saiseikai@yahoo.co.jp
Telephone: +81-3-32938111 Fax: +81-3-32938111
Received: September 11, 2018
Peer-review started: September 11, 2018
First decision: October 5, 2018
Revised: October 15, 2018
Accepted: November 7, 2018
Article in press: November 8, 2018
Published online: December 15, 2018
AIM
To compare the outcomes of endoscopic submucosal dissection (ESD) for gastric neoplasms using Clutch Cutter (ESD-C) or other knives (ESD-O).
METHODS
This 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.
RESULTS
A 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).
CONCLUSION
ESD-C achieved shorter procedure time without an increase in complication risk. Therefore, ESD-C could become an effective ESD option for gastric neoplasms.
Core tip: Propensity score matching was performed to compare the outcomes of endoscopic submucosal dissection (ESD) for gastric neoplasms using Clutch Cutter or other knives in this single-center retrospective study. Forty-four pairs were matched in this study. ESD using Clutch Cutter achieved shorter procedure time without an increase in complication risk (median procedure time; 49 min vs 88.5 min, P < 0.01). Therefore, ESD using Clutch Cutter could become an effective ESD option for gastric neoplasms.
