This article is an open-access article which 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/
Kazuya Akahoshi, Shinichi Tamura, Endoscopy Center, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Keishi Komori, Kazuaki Akahoshi, Shigeki Osada, Yuki Shiratsuchi, Masaru Kubokawa, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Author contributions: Akahoshi K wrote the paper; Akahoshi K, Komori K, Akahoshi K, Tamura S, Osada S, Shiratsuchi Y and Kubokawa M revised the manuscript for final submission.
Conflict-of-interest statement: Kazuya Akahoshi and Fujifilm have applied for a patent for the Clutch Cutter described in this article. Japan, China, and the European Union have already granted patents. Keishi Komori declares that he has no conflict of interest. Kazuaki Akahoshi declares that he has no conflict of interest. Shinichi Tamura declares that he has no conflict of interest. Shigeki Osada declares that he has no conflict of interest. Yuki Shiratsuchi declares that she has no conflict of interest. Masaru Kubokawa declares that he has no conflict of interest.
Open-Access: This article 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 NonCommercial (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/
Received: February 9, 2021 Peer-review started: February 9, 2021 First decision: May 13, 2021 Revised: May 24, 2021 Accepted: July 16, 2021 Article in press: July 16, 2021 Published online: August 27, 2021 Processing time: 191 Days and 22 Hours
Abstract
Endoscopic submucosal dissection (ESD) is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors. Although numerous electrosurgical knives have been developed for ESD, technical difficulties and high complication rates (bleeding and perforation) have limited their use worldwide. The grasping-type scissors forceps [clutch cutter (CC)] is the first forceps-type resection device developed with reference to hemostatic forceps. The aim was to allow easy and safe ESD throughout the gastrointestinal tract, as a biopsy technique, using one device. The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue, for safe and effective incision and hemostasis during ESD. Reported clinical studies showed that ESD using the CC (ESD-CC) is a safe (perforation rate: 0%-3.6%; delayed bleeding rate: 0%-4.2%), technically efficient (en-bloc resection rate: 88.9%-100%), and single-device method for dissecting early-stage gastrointestinal tract tumors. The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp, pull, and coagulate and/or incise actions using an electrosurgical current. The reported self-completion rate by non-experts was significantly better with the CC than with conventional knives (61.7% vs 24.5%, respectively; P < 0.001). Furthermore, the CC is used for other endoscopic therapies, such as endoscopic polypectomy for large pedunculated polyps, endoscopic myotomy for Zenker’s diverticulum, endoscopic treatment of buried bumper syndrome, and endoscopic necrosectomy for wall-off pancreatic necrosis. The initial reports using CC for these therapies have shown favorable results. In this review, we describe the structural features of the CC, how to use the instrument, efficacies of ESD-CC, and other unique endoscopic therapies using the CC.
Core Tip: The grasping-type scissors forceps [clutch cutter (CC)] is the first forceps-type resection device developed with reference to hemostatic forceps. It was designed for easy and safe endoscopic submucosal dissection (ESD) throughout the gastrointestinal tract, as a biopsy technique, using one device. Unlike knives, the CC is a thin pliers-like forceps that can grasp the target tissue accurately and perform sufficient hemostasis and incision. Reported clinical outcomes of ESD using the CC (ESD-CC) are good. This review describes the structural features of the CC, how it is used, the effectiveness of ESD-CC, and other proprietary endoscopic treatments performed with the CC.
